Writings of Dr. Charles
The stories of the last Tuesday and Wednesday on the obstetrician and "perinatologist" Dr. Hamid Safari of Kaiser Fresno reminded me of my several interactions with him during my 18 months of ER work at Kaiser Fresno 1997-1999. So I have a few comments to add:
1) he was extremely arrogant;
2) he liked to apply rules that kept patients out of the hospital - Kaiser's primary money making goal - even though it put pregnant women at high risk; in one case a woman with excessive vomiting suffered her third miscarriage related to his blocking of admission;
3) he had no hesitation to cause extreme pain - the opening of a full C-Section incision without giving an IV narcotic first to block the pain; I heard the screaming, saw what he had done, and told him in the hall that I was ashamed to share the same profession;
4) that he was part of a department that tried its best not to come down to the ER to solve OBV-gyn problems and in particular told us to call the general surgeons instead for problems with potential miscarriage below 23 weeks gestation - as if those fetuses who might have limited brain function due to being too early should be viewed as abdominal tumors.
Thus I have no problem believing that he was just as bad upstairs in labor and delivery - the mixture of arrogance, do things too fast, ignore pain control, keep people out of the hospital on phone calls, delay expensive treatment like C-sections, and generally keep patients at risk. Pregnant patients at risk generally mean their fragile passengers put at risk.
The episode in question of pulling a head so hard as the shoulders got locked up at the pelvic outlet (shoulder dystocia) so as to severe the spinal cord is awful. I have not heard of it in my decades in medicine.
But as Charles Ornstein, LA Times reporter who should get the Pulitzer Prize for his Kaiser articles, stated - the real story is about how Permanente can keep such rotten apples. To me it is about a rotten barrel - one that attracts and keeps rotten apples.
The principal motivation for physicians at Kaiser is to "vest" in the partnership so that they can work their way toward the $15,000 a MONTH retirement program after 20 years. The key talent needed is to say "no" to expensive care and keep the patient/passenger at maximum risk. The legal department through Risk Management will have Cleaners who can mop up the blood and guts and cover up the problems that happen.
The errant physicians actually rise in the ranks to the top because they have proven that they will follow the "group ethic" of business rather than the Hippocratic Oath of patient primacy. It is almost like the Mob or a gang in which you have to have some hits to get ahead. Or else how can you prove yourself to be worthy of the partnership?
The real story is the vengeance Kaiser heaped upon the physicians who finally - not quickly - found that Dr. Safari was so dangerous as to pull them into the tar pit. Rather than being at the top - as the "high risk pregnancy" expert - he was the "high risk" physician making the whole department stink. One of the physicians got out of the business. Another commutes to work; 2 hours each way - seeing his family on weekends. All seemed to have lost "bonuses" for speaking out.
Permanente runs Kaiser. Permanente is a sick corporation with the goals of fooling the public with white coats. Long training is turned on the public to give the illusion of care. Increased death follows increased risk from their many strategies of doing less to make more. This year KP will make some $2 billion in profit - half goes to the physicians.
My own recommendation is that the top Permanente leadership go to jail for a long time. They have spent 60 years in perfecting the illusion of care and many innocents die. All those who have spoken up against Permanente should be called back in to be part of the solution - a new medical care organization that forces white coat physicians to live up to the white coat ethic.
Charles Phillips, MD, FACEP
Cross Referenced with:
original source - http://www.latimes.com/news/la-me-kaiser16oct16,0,684129,full.story?coll=la-tot-topstories
related story - The United States has a sharply higher rate of women dying during or just after pregnancy than European countries, even some relatively poor countries such as Macedonia and Bosnia, according to the first estimates in five years on maternal deaths worldwide. - http://www.reuters.com/article/newsOne/idUSN1339620220071013?sp=true
mirrored for historical purposes and supporting document at:
Kaiser Responds to the above article at: http://xnet.kp.org/newscenter/kpresponds/2007-10-15.html
and we have mirrored the response for historical purposes with brief commentary at: