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Selected Writings of Dr. Charles Phillips - 
Former Kaiser Permanente Physician

It is very important that everyone read all of this letter including the very revealing footnotes.  Please send a copy of this letter to Congressman Pete Stark to make sure that he sees it.  The web form to fill out and send him a letter for people all over this country is at the House Ways and Means Committee at:
He will not respond if you send it to his local district office unless you reside in his area.


Charles Phillips, MD, FACEP
2216 E. Los Altos Avenue
Fresno, CA93710

June 26,2004

Congressman Peter Stark and
Other Members of the Subcommittee on Health
With in the House Committee on Ways and Means
239 Canon HOB, Washington, DC 20515

Dear Congressman Stark and other members of the Subcommittee on Health
of the House Committee on Ways and Means:

Thank you for reading this letter from me, a physician in Central California spending half of my time trying to understand 

responsible health care policy1Please read it all as no short summary would do the HMO issues justice.


As a Board Member of the Managed Care Reform Committee (MCRC) and one of its physician advisors, I would like to 

share with you that this last few weeks has seen several events in Washington, DC, that further threaten the health care of 

United States citizens in Health Maintenance Organizations (and even PPOs with HMO rules in the background). Through 

this communication I hope to add a little balanced information on HMOs to help develop a real debate on good and fair policies of government  I work as a volunteer on the MCRC.2

    First in line as a patient care loss event, the Supreme Court repeated unanimously their belief that the HMO Act of 1973 and 

its companion ERISA act a year later pre-empt the 67% of the citizens of this country - all those not tethered in some way to 

government - from being able to sue HMOs on a level legal field. The cases in point revolved around the withholding standard of 

care testing and treatment to two separate citizens in Texas.

    Yet all those people who are empowered to vote or decided on these issues - including all members of Congress and all of 

the Justices on the Supreme Court - can sue their HMOs and thus get a first tier of care. All such people should recuse 

themselves from deciding if the other 2/3rds of the country should have their right to sue or agree not to exercise their elite and 

self created rights until there is final equity in justice for all.

In fact, this right to sue for damage from health plans was available to all people until it was taken away by Congress through the 

HMO Act and its ERISA companion. The Chief Justice of the Supreme Court has explained a few years ago that the HMO

construct is "the creature of Congress." The courts can not undo the legislative misadventure much as they might wish to.

    So the buck lands nowhere else but on Capitol Hill. In fact, the whole campaign on patient safety was - according to the USA 

Today (and I concur) - developed as a managed care distraction to focus on the front line care givers and away from the rights 

of patients to sue fraudulent Plan decisions. Now, patients are a bit saturated with all the safety verbiage and are wondering once

again about the right of HMOs withholding needed care, the most unsafe aspect of US medicine in the country. And patients want

back the dignity of having a confrontation with a health plan in front of a jury of their peers for resolution and not to be forced into 

arbitration contracts).

    Second, and more specific to your committee, all of you heard a presentation by Andrew M. Wiesenthal, MD, on June 17, 

2004 (Attachment #l) which asked the government to set Information Technology standards which might best fit Kaiser's current 

efforts. This would over time have the value to Kaiser of about a billion dollars. He also hinted at the need for government 

assistance in Kaiser's $3 billion IT investment, forgetting to mention that Kaiser's profit last year of almost a billion - if repeated 

for the next few years  would pay for it just fine.

    The problem is that with this handout request through a Kaiser physician and senior, for  profit partners, there appeared to be 

alternate person able or willing to present the real  inner workings of Kaiser to give you another view to consider. If you proceed 

in  Kaiser's path without opposing information, you will have guaranteed Kaiser an edge  over all competitors for the next thirty 

years - a huge gift.

    But Kaiser is a medical Enron that with all its venture investments and schemes. The  HMO runs completely opposite all of your

efforts to separate patient care into clear units  without kickbacks in your Stark I and Stark II strategies. Kaiser's exception to all 

the  rules makes the HMO - once again - the creatures of Congress. The exception concept is  that a large enough group of 

physicians could not have sufficient greed to each hold the  other to bottom line business practice where patients become 

"external customers" and  get less care. (Notice in Attachment #2 file attached Kaiser picture of patients as  "external 

customers.") I wish to tell you that such widespread greed has become the  more traveled road.

    So, at least for the Congressional Record if not for your careful reading, let me share with  you the following thoughts to give 

you a chance for balanced, patient oriented thinking  that may help you with your upcoming decisions.  My comments will be 

divided into  two parts - 1) Kaiser Permanente as an organization, and 2) Dr. Wiesenthal's particular  presentation and request 

for aid to Kaiser.

Kaiser Permanente-

    This prepaid health plan began with a physician named Sydney Garfield who decided after Los Angeles residency to try his 

practice of surgery outside of city and out in the desert along the path of the Los Angeles Aqueduct from the Colorado River. It 

was the Depression and there were not many jobs for average surgeons in the City of Angels.

    His desert hospital was called "The Contractor's Hospital" - causing no confusion of whose primary interests he would really be

serving. He quickly learned that getting prepaid was the only way to go and secured that system through businessmen in San

Francisco organized through the Business Exchange to supervise the building of the aqueduct. His care was cheaper than 

sending patients all the way to Los Angeles. Often he drove his makeshift ambulance himself.

    Dr. Garfield pocketed $250,000 during four years of the depression in his personally owned, for profit, prepaid, health 

business. With the money he bought many apartment buildings in Los Angeles.  At the same time, his nurses often worked 

without pay. This is all clear in a book Kaiser Doctor Smilie wrote about Kaiser with help from many at Kaiser - a book (Can 

Physicians Manage the Quality and Costs of Health Care? The Story of the Permanente Medical Group) probably 

meant to be used internally to motivate new physicians. The book remains Kaiser's only sanctioned, detailed history.

It will never be found in any of Kaiser's 300 (?) patient education rooms.

    Henry Kaiser, Sr., teaming up with Bechtel and others, became involved in dam building and later ship building. These 

businessmen and also wished workers to get care in business friendly clinics and stared working with Dr. Garfield. Liberty ship 

building for England entrenched the Kaiser-Garfield team in the West Coast around the cities where the building occurred.

    And Kaiser is still 75% a California care system, having to retreat from many states - New York, Texas, Missouri, etc. It seems 

that New York patients really wanted a choice of doctors. Dallas did not like finding 20 wrongful death cases filed soon after 

Kaiser arrived.  The Mid-Atlantic beltway operation of Kaiser was simply another health plan bought as it moved out. This Kaiser 

unit has been a steady income loss to Kaiser. But it is a chance to make Congress believe that Kaiser is really national.3 , 4

    "Dad" Bechtal taught Henry Kaiser from the beginning that the only good business systems create a 50-50 division of profit. 

And so as it was as Henry Kaiser, Sr. and Sydney Garfield, MD, split profits, settled in Lafayette, California, living nearby one

another, and even marrying sisters.  And so it evolved some 60 years ago as the physician groups - having bought out 

Dr. Garfield - negotiated in a beach home owned by Henry Kaiser the internally key profit division of 50-50 between 

the Kaiser Hospitals and the for profit Permanente groups.

    This Tahoe Agreement, which may be read by your committee as needed (signature page enclosed as Attachment 

#3 with Sydney Garfield, MD, only willing to use his first name) set up the most lucrative physician reward system in 

the country - some 3,000 senior partners becoming rich taking care of those patients with few choices -

the elderly, those with moderate jobs, and the poor.

    On the enclosed Permanente Map (Attachment #4) - enhanced by me so as to readable by thoughtful people outside of Kaiser

- you can see that the little figure of Lake Tahoe is prominent in the history of Kaiser Permanente. That building on the beach is 

not about a Kaiser Clinic but rather the location of a fundamental kickback scheme. An update national agreement in 1997 

spelling out the same profit split and even more physician control - as evidenced by a photo op picture (Attachment #5) and 

article - has been referred to internally as Tahoe Two. It is all about renewing the kickback profit for doctors.

    As your Medicare investigators discovered in the mid 1980s but never emphasized to the people. Kaiser builds in 

its profit goals (3-5% of the budget - a budget now at about S22 billion a year) as the next year's business plan is 

created jointly by the physicians and management. Administration and the physician leaders share the same 16th floor of 

the same building. Once the appropriate fee per patient per month is decided by the highest executive committee - the National 

Partnership Committee now co-chaired by Dr. Francis J. Crosson [and Mr. Halverson] - there is a pretense of an "arms' length" 

contractual negotiation to solidify the amount.  The amount is about $70 per patient per month now.  This profit goal is reached by

giving patients about half of the services that are expected by national standards societies - the American Heart Association, etc.

One of the key elements is blocking patients from hospital beds and kicking those that get in out early - each physician having 

daily to justify each day in the hospital to a lay business type person with no license. One patient died as such a verbal

contest was occurring in the hospital hallway; the Kaiser physician - who was trying to do the right thing - decided to do no more 

hospital care thereafter.

    On the same Permanente Map please note that the physician patient relationship in the early part of the voyage to  

investment capitol is later replaced by the Permanente Patient Relationship on the captains' wheels. This allows the 

"wind" of the system to substitute the Group Ethic [read profit motive] for the Hippocratic Oath. In fact, the Kaiser 

physicians believe that all patients have some unwritten contracts with them - like spending less on the really sick 

patients so the premiums are kept down [or profits are kept up. They publish all this for internal motivation

- agreement on the "genetic code" of Permanente Medicine - but it can be put together when needed. The articles in 

the Permanente Journals which are not emphasized on the front cover should be a must read for anyone in Kaiser. 

And this map should be studied daily by your staff.

    The goal of the Permanente fleet of for profit units are to keep to the two goals on the right side of your copy of the 

map - A) a "sustainable future" meaning the huge retirement monies hidden non-profit under the Kaiser Plan by a 

special IRS deal, and B) investment capitol from Silicon Valley [and New York City in the way of bonds] to have

the leading Information Technology system possible.  They do not mention all the many for profit ventures 50-50 

between the Plan and the Physicians (the latter using the vehicle of the Permanente Federation and the Permanente 

Company or Permco) which allow Kaiser to often be on both sides of many business contracts.

Note that CareTouch was a company developed free within Kaiser using its computer systems (a $14 million value of technology)

and then floated out as a private company with Dr. David McKinnon Lawrence still on board. I don't think even Congress could

ever map out Kaiser/Permanente full organizational chart (boards in charge), real operational organization (doctors in charge), 

profit investment systems, showing up on both sides of a contract (e.g. dialysis care), etc.

    Kaiser exists and flourishes because of media silence (ads on the radio and in newspapers), contributions to government, 

special treatment to government patients, toothless Department of Managed Health Care, sleeping regulators who like prime rib

while reading contrived notebooks, and the huge help of the federal government.  To the federal government's help there has 

been deferring Dr. Garfield from the draft in WWII so he could build his private, for profit clinics in free government buildings; then 

giving the same buildings to Henry Kaiser and Dr. Garfield almost free after the war; then giving huge grants to Kaiser for patient 

testing (1961); then allowing Kaiser to use high pricing on meds to get bloated Medicare financial credit; next letting Kaiser 

design the HMO Act of 1973 and the ERISA protection a year later; then further supplementing Kaiser as a federal HMO for more

startup funds; then the special IRS ruling party "X" and party "Y" that lets physicians amass delayed, tax free fortunes; then 

exemptions from Stark I and II conflict of interest rules; then heavy input into the Clinton plan for health; lack of scrutiny of ads for 

Senior Advantage in the Medicare Plus Choice office; disinterest as Kaiser pretends that it was aligned with CDC guidelines on 

anthrax 5  AHCPR Grant HSO 6680 to help Kaiser write a book on how the sickest of patients have to manage their own care6 

and now the invitation by your committee to perhaps have Kaiser set the standards for medical information systems. This is a 

win-win-lose - Kaiser wins big profits, government has chance to secretly ration care without yet sharing any blame, and an 

patients are abused by this terrible system of non-care - a business plan masquerading as health care. Kaiser is the leading 

cause in this country of senior abuse.

Dr. Wiesenthal's Presentation to You - June 17,2004 (attached)

Here are my comments about this HMO7 infommercial: 1. Dr. Andrew Wiesenthal presented to you that Kaiser Permanente

uses its information technology to help patients and physicians access clinical information to further patient care; what he

did not explain is that one of the main purposes of the computer is to monitor every physician on every possible patient

care activity - prescriptions, specialty referrals, pharmacy costs, lab costs, out of system referrals, etc - so that each MD will

be judged in all areas as a "business center" - particularly when being observed for the first two years before ascending to

Junior Partner and for profit level:8

2. The text suggests a fairly smooth progression from his IT work in Colorado, then the CIS system under Dr. Lawrence,

and then the replacement with tlie EPIC/Cisco system brought in by Mr. Halverson; rather the truth is:


A. one day Kaiser Oakland grabbed the mainframe computer in Kaiser Colorado and took it back to

California because Dr. Wiesenthal and others in the mile high city wanted to stay with their regional

system and Dr. Lawrence wanted to show his central power as Kaiser's chief;

"Kaiser, five years and some $2 billion in IT investments later, is still trying to make progress, and the 

cultural uproar triggered by Lawrence's no-holds-barred ultimatum still rankles. For some, Lawrence's 

decision was akin to a declaration of war. "Up until the time of his decision, " says Henry Neidermeier, 

a Kaiser IT executive in charge of Web development, "Kaiser was run as a collegial organization, not 

like a corporation. Physicians had been making all the decisions. " Lawrence, a former physician 

himself, says it was the toughest management decision of his career. "It was a unilateral action, " he 

says. "I was deeply criticized and resented. I had several very, very uncomfortable conversations with physician leaders.

"Lawrence says he remembers more than one shouting match with physicians he had known for years,

including several calls by some physician's for his ouster.
Andy Wiesenthal, a doctor m Kaiser's

Colorado region recalls: "There was open
dissent ... It was a very difficult time. " Almost overnight,

Wiesenthal, -who was
critical of Lawrence's mandate at first, suddenly found he no longer had an IT

department to generate his analytical reports - it had been dismantled and most of
the IT workers were

relocated to Kaiser operations in California.  "All the people
were gone. The rooms were empty. The

mainframe was removed." Wiesenthal
says.  "The message was impossible to miss. "

Case Study: Kaiser Permanente by Eric W. Pfeiffer
- 4/15/2002
Note that $2 billion was wasted as this 2002 CIS system was later scrapped; the new $3 billion figure includes some of the past

wasted money.
B. the physicians reacted by requiring a new partnership agreement in which there are no such surprise moves,

 a non-physician would be the next head of Kaiser, and the 50-50 power relationship would prevail at the top

executive committee. Dr. Crosson being the co-chair [the other co-chair is never mentioned but is most likely

Mr. Halverson himself];

C. switching to the EPIC/Cisco's system involved going to a small player in the field and allowing Mr. Halverson 

to dump most of Dr. Lawrence's top administration; the real question is whether or not the many venture 

systems at Kaiser are caught up in the EPIC contract whereby promoting this system makes

more kickback money for Kaiser's many venture projects9 (my estimated chance of this is 99%10;

D. Kaiser has a "license" from EPIC "to use and deploy EPIC'S suite of software"; its attempt to create the 

brand name "KP HealthConnect" is for the purpose of trying to make this IT system look like it is an in house 

creation to the public and to you;

E. Adam Kiefert changed employment from Epic Systems Corp. in Madison, Wisc. to work with Kaiser IT in

Colorado Kaiser - "I'm the only person here who knows the system, which puts me at a great advantage"; so

this is not about a smooth expansion of the original system; (from Biomedical Engineering Alumni Profiles -


Adam Kiefert - Class of 99 - MSOE - perhaps four years out of college, he was one

year ago the lead person in Kaiser Colorado IT Department11.

F. Kaiser is basically bragging aboat a system it has had in some places about one year after two

other, different IT systems failed to do the job;
setting government standards around them would not make


3. In the presentation to you. Dr. Wiesenthal avoided repeating the lie that Kaiser Permanente is "non-profit"; but outside of

the beltway, this phrase and illusion is passed on to the public in a thousand ways - news releases, newspaper ads, radio

ads, etc. (even on the Kaiser reference in Google);

4. Only the Washington DC Kaiser unit (mid-Atlantic) tells the truth in its ads that only the Kaiser "Plan" is non profit, since 

then Permanente physicians are for profit; so Kaiser is careful where you can listen and watch but cavalier where you cannot

keep track of what they are saying to the nation.

5. In Kaiser's bond release this Spring of 2004 aimed at investors in New York, it was clear that Kaiser had "more than

11,000 physicians"; for you they rounder the number up
to " 12,000" just to try to look bigger as information in this HMO is

made to be spun;

6. Dr. Wiesenthal suggested that through the Public Health Grant of 1961 that Kaiser had "internists 

armed with computer print-outs of pertinent medical data"; I am quite sure that this was not true and the 

Cleveland Clinic and many others would dispute this; (I visited Kaiser in San Francisco in 1967 during a 

search for internship and saw the lab printout which was long but not unique12.

7.  With the Public Health seed money for testing withdrawn long ago, Kaiser now does the least testing 

possible and even publishes articles to the same effect in the Permanente Journal; so the real goal is now 

reversed - full chemistry panels looking to uncover disease are rare - but the organization would still like 

the multiphasic testing mystique to be attached to the Permanente brand name.

8.  I review new Kaiser patient records about once a month with patients or surviving relatives permission; 

I have yet to see an easy to read, computer printout of information;

9.  While Kaiser Colorado is heralded in this report to your committee as wanting information to flow well, 

internally the physicians have been counseled one on one not to ask for the old chart of patients so 


10. Next Dr. Wiesenthal quotes an anonymous Kaiser physician in an anonymous location (? real or not) 

being able to complete a consult on the same day; I would challenge Kaiser to come up with the author, (it 

sounds more like a chapter theme from Dr. Lawrence's book from CHAOS to CARE using fictional 

characters; the book was written after Helen Hunt commented in a movie about HMO failures and got 

audiences clapping around the nation in otherwise before and quiet theaters)14;

11. Contrast this to the reality of a Washington D.C. patient holding a job who came into Kaiser on 

January of one recent year saying he had Hepatitis C and needed a Gl visit only to have no Gl 

appointment at all with liver failure death coming 8 months later, speedy consults are not the 

internal reality of Kaiser computers or not;

12. An attached cartoon (Attachment #5) - a sample of Kaiser's twisted humor - shows the real attitude that

rapid care costs money - don't hire enough surgeons despite patient backups in surgery; in one location in

Northern California Kaiser was caught giving out bonuses to Call Center employees who could handle a 

patient problem on the phone without giving away a physician visit time;

13.  Then Dr. Wiesenthal promotes the idea of the computer as "on-line, real-time support information" for 

physicians; actually these are popups on the computer which the physician must follow or explain why not 

- an example of the illegal practice of medicine by a corporation like an unlicensed, for profit Permanente 


14. The pop-ups are not state of the art suggestions but ratlier crude business suggestions like using 

medications from the 1970s and 1980s - Tolinase for diabetes, barbituates for depression, etc.; these type

of suggestions are also in pocket handouts given to all the physicians (surprise check any Kaiser white 

coat or nearest drawer);

15. As Kaiser is now trying to avoid putting diagnoses on patients so they cannot check them on the 

Internet, the "after-visit summary" will not be thorough to the care;

16. "Team care will be more patient centered" comes from the decision in 1997 within the Recovery Plan 

for 2001 to increase membership, retire physicians, and substitute nurses, pharmacists, dieticians, and 

others for MDs; physicians were to try to phone patients and have them write letters back15 to keep the 

clinics less crowded - all being separating the physician from being the personal friend they try to 

advertise on the radio.

17. So noting that visits to the MD go down is not about electronic care but a planned reduction 

in physician-patient time; this did result in getting profits back up - nearly one billion dollars last 

year (half to the physicians).

18. "Finally, clinical research to support evidence-based care will be greatly enhanced" is mentioned, but 

Kaiser is the HMO that most hides its supposed "evidence-based" material from the world; on the Internet 

it can only be found on the Kaiser Papers Website, one run by a Vickie Travis with our support of 

materials and totally unauthorized by Kaiser,

19. The Clinical Practice Guidelines pretend to be a reflection of national standards but are not; 

for example. Kaiser will not search its obese patients for diabetes despite the American 

Diabetes Association pointing out the obvious - that this is a good group to screen for 


20. Dr. Garfield taught - opposite to all the Kaiser ads - that Kaiser dispenses wellness not sickness care; 

together with his "economy of shortages,"17 often no care occurs at all.

21. On page 4 of his report to your committee, Dr. Wiesenthal completely avoids the fact that Kaiser 

scraped its internal IT program in 2003 and went with an entirely new, outside brand from Wisconsin for 

which it had no training; ratlier he states "This explains why we have worked so hard to help the industry 

develop the tools that are the foundation of many systems now in use or development"

22. The goal of his presentation finally becomes clear -it is a request for more money from the federal 

government - the "provision of targeted financial support for public- private partnerships"; you might as 

well have McDonalds ask to be a central government partner in developing Big Mac standards to be used 

for all hamburgers.

23. No doubt Kaiser and the VA would like to get many dividends from their $2 billion each investment in 

IT - two organizations each of about the same size budget; private physicians would be left behind as well 

as other health plan competitors;

24. Your committee might do well to study the death of a Ven-Cor patient who was getting tired with and 

needed oxygen for the night for safety - and such was ordered - but with all the steps needed to execute

this order of simple care through the computer, the patient missed the treatment and died a suffocating 

death; computers have not replaced people particularly in systems where the money spent on IT is taken 

from other areas that require a lowering down the job training of the front line participant

25. Dr. Weisenthal continues: "We are convinced that widespread adoption of health care information 

technology like KP HealthConnect" [really licensed EPIC] "is essential for sustained quality improvement" 

is a statement that is entirely self serving and should not be accepted for one moment until the web of 

financial relationships and for profit ventures are made transparent for the first time in Kaiser's history; 

otherwise it is simply a welfare handout for the rich (check the million dollar retirement packages of the

senior partners).

26. "The Leapfrog Group has been a leader in the introduction of payment-quality standards, especially 

for hospitals" obscures the fact that Kaiser has also developed self serving "quality" standards; these 

efforts hide the fact tliat Kaiser's real focus is to kick patients out of hospitals before they are well or even 

worse commit them to rogue hospice units with too much uncharted morphine in caregiver pockets.

27. "Ultimately, for payment incentives to have real influence on quality, they should be directly tied to the 

care delivered during a specific time period," and Kaiser with its benchmarking tracking of physicians will 

be the only one ready to supply the demonstration projects; the government will forget in the process that 

the Kaiser physicians already have dazzling incentives to withhold care.

28. Kaiser's good score on a California survey of heart attack ontcomes, as an example, came 

from convincing 25% of the patients at the door that they would not like to have any care at all 

making them DNRs - within the survey the equivalent of dead at the scene; so Kaiser statistics 

are as bad as Mark Twain predicted of all statistics.

29. Kaiser's view of itself- expressed to you as supposedly an organization sharing good ideas - should be

asked by you to publish all of their Clinical Practice Guidelines for physicians (outpatient) and the parallel 

Pathways for physicians (inpatient) each for the first time; instead, they guard these items and the huge 

profit systems as if it was gold buried in Fort Knox not even the AMA getting to peek at them;

30. Medicare and Medicaid made Ross Perot a very rich man by subcontracting data techniques which 

could then be used privately by the same contractor. Kaiser would not mind duplicating that path with its 


31. Both the VA19 and Kaiser make their patients split medications into pieces of uneven fragments just 

to save money even though the patient ends up with a 40% swing in dose (see Timmis v. Kaiser20 case 

now in appeals court); many Kaiser patients start with big pieces and work their way down to dust - does this 

sound like a quality outfit to you?

32. Rather than following Dr. Wiesenthal's congratulating the committee on this "timely and important hearing," 

I would rather remind the committee that if greed were to be removed from health care that there would be 

enough money to provide the right treatments no exception for organizational size; first make greed 

transparent, then hold hearings on IT standards.

33. And I would ask each of you as former patients somewhere in the past if you did not get the best care of

your life when you could truly go to the physician of your choice and
cultivate the patient-physician relationship

promoted and promised by Hippocrates as an
oath and a covenant - the whole meaning of the white coat; and if

so, do not presume that
forcing all private physicians to spend tight dollars on system electronics will result in

even the slightest improvement in care.


Every time Kaiser Permanente representatives make a presentation to Congress, a minority report should be allowed so it is

clear that free thought is possible. Hearings
should not be used as preparations for enabling and assisting HMOs, as has been

done so
many times in the past. If Congress cannot regulate HMOs, at least let others through

letters like this make them transparent. The public expects no less.

Dr. David McKinnon Lawrence - former Kaiser CEO who now exports Kaiser ideas (of empty hospitals) to England - and I were 

both premeds on the Amherst College campus just one year apart. But we have taken different paths and have an entirely 

different vision of medicine and the covenant of good care.

Dr. Lawrence believes that the Marcus Welby, MD, TV show was not helpful to patients and only described the "lone eagle" 

practitioner who has become extinct in this new era of medical economics. As a small town physician with a sound education, 

board certification, and 35 years of real medical practice, I would encourage you to let both eagles with patient compassion and 

accountants still wearing MD white coats compete so patient advocacy will not be banished from this planet

In the final analysis you need to understand the Group Ethic versus the Hippocratic Ethic and know which one you are really 

funding. Your own personal health depends upon it as well as the health of all whom you represent.


Charles Phillips. MD. FACEP


'  I am a near constant participant in the Dialogue chat group of the Health Administration Responsibility Projectrun by Harvey Frey, MD, PhD, and JD.   (

2I have worked 90% in the US (California, Nevada, Utah, Minnesota, and Guam but have also seen patients in Canada, New Zealand, Thailand, and Saudi Arabia, in the latter situation once being on call to the King in case of emergencies.  I have also visited health care delivery in Japan (riding out with ambulances) and health care teaching in the Philippines.

3 One published, internal strategy of Kaiser is to leave a copy of a Permanente Journal lying around your Congressional office to give the illusion that is a nationally accepted journal of medicine and research which it isn't; physicians realize it is more of an internal communication device.

4 Kaiser headquarters in Oakland taxed its Missouri Permanente physician group $3,000,000 a year to artificially support the mid-Atlantic unit. When the Missouri operation closed as a failure, the physicians suing Kaiser brought that up. Another issue was loss of profit equity.

5Kaiser taught its clinics that Anthrax presents with shortness of breath and a low oxygen reading; the truth is that Anthrax goes to the middle of the chest and creates sudden, life threatening problems - and organisn that makes elephants drop in shock just before death. Only a chest CT can screen for Anthrax as the CDC knows. Kaiser did not learn when it cost the life of a postman working on mail on the way to Congress; he came in asking to be screened for Anthrax and went home to die. Don't go to Kaiser if you think you have Anthrax.

6 Kaiser Permanente LIVING A HEALTHY LIFE WITH CHRONIC CONDITIONS - Second Edition - Self Management of Heart Disease, Fatigue, Arthritis, Worry, Diabetes, Frustration, Asthma, Pain, Emphysema, and Others, lf "frustration" is a disease, then patients who ask for full service care - as the ads promise - will be considered ill; Kaiser undermines self esteem when someone fails to be Kaiserized into accepting substandard service.  The book can only be loaned to patients by Kaiser - like the one I have has a library card type return policy. Patients get two weeks to learn how to manage their diabetes.


7Kaiser hates to be reminded it is an HMO, since the Kaiser Family Foundation has through its paid time for surveys in the Washington Post proven HMOs to be near to hated. Instead, the goal is to create the Permanente physicians as the Brand Product - highly selected, good listeners, the hands of healing, and rewarded only by pure salary. One ad firm alone is getting $40,000,000 this year to promote this concept, one far from the truth.

8 The physicians learn once a month in peer group meetings how they stack up as a business unit with the hope that for profit peer pressure will Kaiserize them into cooperating. Those failing to abandon their advocacy oath next get the 1:1 private warning - shape up or ship out. Those still failing are told that they are not manage care compatible - as if there is another legitimate form of medicine. The American College of Emergency Physicians has given clear expression to the idea that there is only one form of medicine.

9 Most of these ventures also are 50% owned by the plan and 50% by the for profit physicians; the IRS does not care if a non-profit plan is 49% for profit.

10 Kaiser physicians often balk lately at filling out the California Medical license renewal at Item G - "I certify under penalty of perjury that I have disclosed on this renewal application form (see reverse for space) the names of those health-related facilities in which I or my family have a financial interest or I certify under penalty of perjury I have no financial interest to disclose."  An audit would occur if the Board was not so connected to Kaiser - for example, a disproportional number of its medical "experts."

11By the way if you caB for emergency help through Kaiser m Denver your call will be handled just out of
Madison Wisconsin by dispatchers with little training but connected to Kaiser through another profit contract - See USA Today story.

12Kaiser would have paid me more than other intemships, but I wanted a real education through the San Francisco General Hospital with university teaches still on oath target. Kaiser's letterto me this week inviting me back to a high salary will also be unanswered, I am not for sale.

13 I am also sure that Kaiser has a difFicult-to-read keystroke for records going to patients {roro the Kiser legal office; this is designed to fiustrate outside medical expert opinion.

14 This book was written on a prolonged retreat outside as Dr. Lawrence became more advisory in his final year to the incoming CEO. The book demonized the average, private pediatridan. Book sales have not been brisk.

15 One Kaiser paient tried to write her physician about he allergies, but he kept giving her the wrong medications and not seeing her, the Kaiser pharmacist spent most visits flying to talk her out of prilosec.

16 The Managed Care subcommittee of the American Diabetes Association (ADA) waters down some of the recommendations; Kaiser really wrecks them internally. But the public is told that Kaiser is busy partnering with the ADA so all of the patients are fooled all of the time.

17 See Dr. Smilie's book for the time and place of this teaching moment

18The richest man in Thailand did much the same - helped developed cable TV and then bought up all the franchises
with his insider knowledge; his name is Thankin and may be the current prime minister enriched by public-private
partnerships that lead to enormous greed and a higher expense for each Thai to use.


19I did work at a VA within the past few years. For all the emphasis on safety, the light bulb was off where the physicians select the night medications. And the x-ray tech was forgetting to collimate (protect) the patient from excess radiation.

20 Audrey Timmis was my patient and is still my friend. She was and is lead plaintiff on this case.  Why wreck the medications of a patient already on oxygen? Split fragments would fly across the room when her husband tried to spirt one hundred into two hundred doses of blood pressure pills. The suit is lead by the Trial Lawyers for Public Justice. I am a volunteer. Kaiser has video taped me for 12 hours on the case so far.


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