Kaiser Foundation Health Plan fined $500,000 in 19-year-old patient’s death

By Jennifer Coleman Associated Press Writer
Monday November 19, 2001

SACRAMENTO – State HMO regulators fined the Kaiser Foundation Health Plan Inc. $500,000 for failing to give a timely referral to a 19-year-old man who later died. 

Timothy Water’s mother requested a referral to a muscular dystrophy specialist at the University of California, Davis Medical Center, said Daniel Zingale, director of the state Department of Managed Health Care. 

Most children diagnosed with Duchennes muscular dystrophy begin having respiratory problems in their late teens. When Waters’ mother Junette LaLonde noticed her son was having problems breathing, she first called the specialist at UC Davis. 

“They said they couldn’t see him unless they had the referral,” said LaLonde, who lives in Stockton. 

Waters died six days later without a referral, Zingale said. 

“The requirements are for a timely referral and in this case, timely would mean immediate,” he said. “We think it was a failure of the HMO’s system.” 

Waters died in August 2000. 

Zingale said Kaiser officials cooperated “in good faith” during the department’s investigation. 

“But what we haven’t had is an acknowledgment of the system failure and a plan to correct the problem,” he said. 

Kaiser officials said they hadn’t been notified of the fine and couldn’t comment on it. But spokesman Tom Debley said the health plan wanted to “express our sincere sympathy for the family of the young man.” 

Debley said Waters was under the care of doctors at both Kaiser and UC Davis, and that Kaiser was still conducting an internal investigation into the case. 

Zingale said Waters had been treated at UC Davis previously “but in this episode, everyone was acting as if the patient needed a referral. If in fact a referral wasn’t needed, the family certainly needed to know that.” 

The HMO was responsible for ensuring “continuity of care and it failed to do so,” he said. 

LaLonde said she hopes the fine will encourage Kaiser to “change some of their rules.” 

“Tim had special needs and a special case and they should have sent the referal quickly knowing that,” said LaLonde. 

The department has issued fines against HMOs in the past for failing to give a prompt referral, but this is the first related to a fatality, Zingale said. 

Kaiser is California’s largest HMO with 6.2 million members statewide.