medical

The California attorney general will help oversee healthcare giant Kaiser Permanente’s medical arbitration system to ensure it operates fairly under legislation Gov. Gavin Newsom signed late Sunday.

Patients, their families and lawyers have complained that Kaiser’s private and confidential system of handling medical malpractice complaints is designed to favor the health plan over those bringing the claims.

Under legislation known as Assembly Bill 1770, the attorney general will decide what actions justice officials should take to ensure private arbitrations required by any health plan are handled fairly and in line with state law.

To do that work, the state plans to add as many as four deputy attorneys general, a legal analyst and three legal secretaries, according to a legislative analyst’s report.

“We look forward to continuing to resolve claims through an independently administered system that provides a fair and efficient process for members and patients,” Kaiser Permanente said in a statement Monday.

Roughly 1 of every 4 Californians get healthcare from Kaiser. To join the plan, each one had to check a box, agreeing to use arbitration to settle any dispute.

Many companies and other organizations, including some hospitals and physician groups, require customers or patients to take their complaints to private arbitration rather than to court.

But unlike most other companies, which send claims to large arbitration firms, Kaiser created its own system.

Under Kaiser’s system, once a neutral arbitrator is selected, either party can opt to disqualify that person without cause. There is no limit on the number of disqualifications.

While the health plan designed the system to be fair, patients and their lawyers have alleged that Kaiser’s greater knowledge of arbitrators’ past rulings and its ability to veto arbitrators gives it an advantage to pick favorable judges.

Critics also say the hourly fees paid to arbitrators provide them with a financial incentive to rule in Kaiser’s favor so they will be selected for future cases. Most of the arbitrators are retired judges.

Kaiser has previously defended its arbitration system, saying it was fair for both patients and for the nonprofit.

The bill was authored by Assemblyman Robert Garcia (D-Rancho Cucamonga), a longtime Kaiser member.

Support for it was led by Stephen Martinez, a retired aerospace engineer from Bellflower, who with his wife, Lindalee Iverson, spent $350,000 to bring two arbitration cases against Kaiser. The arbitrator ruled against the couple in both cases.

Iverson died of cancer in 2023.

Martinez told legislators at a hearing this year how his wife had found a lump in her breast and asked for an appointment with her longtime caregiver at Kaiser to examine it. Instead she was sent to a physician assistant, who dismissed it, he said. Later, it was found to be cancer that had spread.

A chief breast surgeon at Kaiser and another surgeon who had retired from that job both testified that the Kaiser physician assistant failed to follow the health system’s guidelines.

Kaiser’s expert argued that the physician assistant did an appropriate exam and that his low suspicion of breast cancer was reasonable. The neutral arbitrator sided with the health plan’s expert.

Martinez has spent years trying to get legislation to make the system more fair.

“I’m elated,” Martinez said of Newsom’s signing of the bill, which was named Lindalee’s Law. “It’s been a long road.”

According to the annual report prepared by the independent administrator of Kaiser’s system, the “most common” complaint the office heard last year was about the neutral arbitrator.

“Most complained that the arbitrator was biased, partisan, unjust, and in Kaiser’s favor,” the report said.

The podcast series comes a week after a public inquiry reported on the case of former neonatal nurse Lucy Letby who was convicted of murdering seven babies and attempting to murder seven others at a hospital in Chester a decade ago.

While the circumstances are very different, Norris’ supporters also argue that his case hinges on disputed interpretations of medical evidence.

The story begins in 2002 when Norris, a 26-year-old nurse, originally from Glasgow, found Ethel in an hypoglycemic coma as she recovered from a broken hip.

Doctors took blood samples to find out what caused her blood sugar to drop so low.

The test results seemed conclusive – she had a massive amount of insulin in her blood.

She died 21 days later, sparking a murder investigation.

A nurse who had been on shift on the night Ethel was found told the police that Norris had predicted the 86-year-old might not last the night.

He quickly became the prime suspect.

The police operation trawled retrospectively through all the deaths on Norris’s wards, looking for potential murders that may have gone unnoticed.

They identified three other cases of unexplained severe hypoglycemic deaths and one where the patient recovered.

No blood tests had been taken from these cases at the time of their deaths to be able to prove insulin poisoning but experts for the prosecution said in court that their medical charts showed persistent and severe low blood sugar readings.

They said that because this was so rare in non-diabetics that it must be murder.

When it came to court in 2007, experts called by the defence said four of the five patients had died of natural causes.

But after a five-month trial and a deadlocked jury, Norris was convicted by a majority of 11-1 and told he would not be eligible for parole for 30 years.

After the verdict, Ethel’s son Stuart Hall said: “I don’t think he should come out again. He’s got the knowledge to commit murder but do it discreetly.”

SACRAMENTO — Three state bond measures are on California’s November ballot. You probably haven’t paid much attention to them. So here’s my read on these big-ticket proposals.

One is a no-brainer “yes.” It would help middle-class Californians buy a new home by allowing them to borrow most of the down payment. And it wouldn’t cost taxpayers a dime. That’s Proposition 37.

Another housing measure is probably worthwhile, but gives me pause because it accommodates too many interests in order to attract broad political support. And it burns a barrel of money. That’s Proposition 1.

The third proposal would fund important medical research. But I wince because it was written to largely benefit one institute that was co-founded and is headed by the measure’s chief backer. That’s Proposition 38.

Propositions 1 and 38 combined would add $18.4 billion to the state’s general fund bond debt, which already is about $80 billion, according to the nonpartisan Legislative Analyst‘s Office.

Plus, there is $40 billion in previously authorized bonds waiting to be sold. The new bond proposals would cost the state at least $1 billion annually for 20 to 25 years. Taxpayers are paying about $6 billion annually to retire state bonds.

Bonds are boring, but they’re also tax eaters. So we should pay some attention before voting on them.

“People think about bonds as free money. And, of course, they’re not,” says Mark Baldassare, polling director for the Public Policy Institute of California. “People don’t think bonds are going to raise their taxes.”

But most bonds are repaid by the state’s general fund, the main cash box that finances major programs such as education, healthcare, prisons and fighting wildfires. Bond debt has No. 1 dibs on the money. When revenue runs short — a common dilemma in Sacramento — other programs must be cut or taxpayers are hit harder. So bonds aren’t necessarily tax-free.

Baldassare released a PPIC poll last week that found a majority of likely voters supporting all three bond measures — especially Proposition 37 to ease homebuyers’ down payments.

The pollster noted that fall election campaigns are just starting and opposition arguments could reduce support for the measures.

But there’s no organized opposition to the two housing proposals. And although the medical research measure has some outspoken critics, there’s no money for an opposition campaign.

OK, a few specifics on each measure.

Proposition 37 is a taxpayer freebie, a $25-billion bond repaid solely by homebuyer beneficiaries. Here’s how it would work:

Middle-income people could pay 3% down on their home purchases rather than the normal 20%. They’d borrow the other 17% as a second mortgage and repay it along with the first mortgage.

The proposition defines middle class as household income that’s less than double the median for the area. Statewide, that income ceiling would be around $200,000 but would vary greatly by locale.

The purchased dwelling must be a brand-new home, whether stand-alone or a condo. That’s to increase the housing supply and create construction jobs. Politically, it gains the support of developers and unions.

No vacation home. It must be owner-occupied full-time. And the buyer must be a California resident.

The state’s sale of revenue bonds would create the down-payment pot. Regular lending institutions would arrange the loans and charge minimum fees. Loan repayments would replenish the pot and make it self-sustaining.

This was the brainchild of Bob Hertzberg, a former Democratic Assembly speaker and Senate majority leader from the San Fernando Valley.

Hertzberg tried several times to sell his proposal to the Legislature, but lawmakers wanted to juice it up with their own pet ideas. “I couldn’t get something just focused on the middle class,” he says. So he crafted this citizen initiative.

Proposition 1 proposes $11.25 billion in bonds for a smorgasbord of affordable housing.

This is the political establishment’s creation — Gov. Gavin Newsom, the Democratic-controlled Legislature and housing interests. There’s no organized opposition.

It was dressed up with $1.25 billion in popular CalVet loan bonds for military veterans. They repay their home loans through mortgages, costing the state nothing.

But the remaining $10 billion in bonds would be repaid through the state general fund, costing at least $500 million annually for 25 years.

The measure is mainly designed to generate affordable rentals for poor people. But to assure legislative passage, money was added for affordable student and farmworker housing, plus other goodies.

It’s a lot of money and makes only a small dent in California’s unaffordable housing plague. Moreover, it seems too scattershot.

But it could spare more people from becoming homeless — living in their cars or on sidewalks, ultimately costing taxpayers even more.

Then there’s Proposition 38, the problematic $8.4-billion general fund bond for medical research, including cures for cancer, heart disease and Alzheimer’s.

The hang-up for me and others is that the ballot initiative was crafted to virtually assure that half the bond money would go to one outfit, the UCLA-affiliated California Institute for Immunology and Immunotherapy. The institute was co-founded and is headed by the proposition’s originator and chief backer, billionaire Gary Michelson.

“I know opponents want to create a billionaire boogeyman, but isn’t curing cancer and other terrible diseases exactly what we want billionaires to spend their money on?” says Robin Swanson, a campaign spokesperson.

Sure. But being backed by a billionaire isn’t the problem. It’s being written to substantially benefit one research institute that’s led by the billionaire.

Two cancer survivors and political opposites — conservative consultant Jon Fleischman and liberal consultant Steve Maviglio — co-authored an op-ed that declared:

“Imagine either major political party proposing to borrow billions of dollars and writing the qualifications so narrowly that an organization founded and chaired by a principal campaign benefactor appears positioned to collect half the money. The other party would rightly howl. So should voters.”

They should at least be skeptical.

What else you should be reading

The must-read: California health clinics accuse influential union and its leader of racketeering in civil lawsuit
Danger zone: Newsom creates panel on AI safety regulation, suggests possible ‘kill switch’
The L.A. Times Special: Union power vs. MAGA politics in California’s schools superintendent race

Until next week,
George Skelton

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RIYADH: The Saudi Food and Drug Authority has granted marketing authorization for two locally developed, artificial intelligence-enabled medical software products — Dental IQ and SAARIA — designed to support dental and ophthalmic diagnosis.

The authorization was granted following a comprehensive regulatory review, including the assessment of technical documentation and clinical evidence to verify the software’s safety, performance, and effectiveness for its intended uses, the authority said. The SFDA in a statement to Arab News said the aim is to enhance diagnostic accuracy for dental and periodontal diseases. Dental IQ utilizes deep learning algorithms to analyze dental X-ray images and support the identification of potential pathological findings, including dental caries, periodontal disease, and structural changes affecting the teeth and supporting tissues.

“This supports healthcare practitioners in improving diagnostic accuracy and informing appropriate treatment planning,” said the SFDA.

SAARIA will enable early detection of diabetic retinopathy. The software utilizes AI technologies to analyze retinal images to support the screening of diabetic patients and the early detection of diabetic retinopathy in healthcare settings.

This supports the identification of patients who may require further specialized ophthalmic evaluation, thereby facilitating timely referral and interventions and helping to reduce the risk of disease-related complications. These two products, according to the SFDA, represent a significant national milestone as the first Saudi-developed AI-enabled medical software solutions in dentistry and ophthalmology to receive the authority’s marketing authorization.

Designed as clinical support tools, they assist healthcare practitioners in making informed clinical decisions. Notably, both software products have been developed by Saudi startups specializing in AI-driven digital health solutions.

The companies enrolled in the SFDA’s Innovative Medical Devices Pathway, receiving early regulatory guidance and fulfilling the relevant requirements.

This included conducting local clinical studies in the Kingdom to validate the performance of their software in local healthcare settings and committing to post-marketing clinical follow-up plans to monitor real-world performance and ensure continued safe use. The SFDA, however, cautions against relying solely on the outputs of AI-enabled medical software for clinical decision-making.

“Such outputs are intended to support clinical decision-making and do not replace the healthcare professional’s clinical judgment. Healthcare professionals are responsible for reviewing and validating the outputs and making appropriate clinical decisions based on the patient’s condition,” said the authority.

The granting of marketing authorization for the software reflects the SFDA’s strategic commitment to fostering responsible innovation in digital health, supporting the localization of advanced medical technologies, and facilitating timely market access to safe, effective, and high-quality medical devices.

This milestone also contributes to the broader objectives of the Health Sector Transformation Program in line with Saudi Vision 2030, which aims to improve healthcare access and quality by enhancing primary care, hospital services, emergency response, and digital transformation.

Some issues can make it harder to find affordable travel insurance

Expert advice has been issued for many Brits planning to go abroad. People with disabilities and long-term medical conditions are being warned to shop around for travel insurance as their health history can send premiums soaring.

Having a medical condition does not mean you cannot get travel insurance – but it can make finding affordable cover considerably harder. Research by Which? highlighted in a new post on X on Wednesday, September 2 found that seven in 10 of its members who had bought travel insurance in the previous two years had declared a medical condition. While most said this had only a minor effect on their ability to find an insurer willing to cover them, many reported that their condition pushed up the price.

One in four said their medical conditions had a major impact on what they paid. The problem can become particularly acute for older travellers.

Data from Compare the Market cited by Which? suggests customers aged over 65 pay roughly double once their medical conditions are taken into account. And simply buying a standard travel policy without declaring a condition could leave holidaymakers dangerously exposed.

Insurers usually require travellers to disclose their medical history, with specialist medical screening companies assessing the risks involved. The resulting risk assessment can affect whether an insurer will provide cover and how much it charges.

But different insurers can make different decisions – meaning it pays to shop around rather than accepting the first quote.

Specialist policies to consider

Which? assessed policies from specialist providers and identified several as Best Buys. Saga came out on top, with its Plus annual multi-trip policy scoring 82%.

It provides up to £20 million of medical expenses cover, £20,000 cancellation cover and £10,000 for baggage and valuables. Saga’s Plus single-trip policy scored 81%, while its Standard annual multi-trip policy scored 77%.

Staysure Signature scored 74%, with unlimited medical expenses cover, £15,000 cancellation cover and £5,000 for baggage. AllClear Platinum scored 70%, also offering unlimited medical expenses cover.

Which? also highlighted InsuranceWith’s Platinum policy, which scored 68% and includes £5,000 of gadget cover.

Don’t hide your medical condition

Travellers should be completely open about their health when buying cover. A medical condition may result in a higher premium or an exclusion being added to a policy. An exclusion could mean claims linked to that condition are not covered – potentially leaving someone facing a huge bill if they become ill abroad.

Which? insurance expert Dean Sobers said there is a reason it publishes information about the medical screening companies used by insurers. The organisation found that 80% of the policies it assessed used Verisk for medical screening, while 12% used Protectif.

This can matter because insurers may reach different decisions about whether to cover someone – and what to charge – even when the same screening process is involved. He said: “When searching for quotes, you may have found yourself answering what feels like identical health-related questions over and over even when trying different insurers. You’re not imagining it: medical screening is outsourced by most travel insurers, with the vast majority using just two firms – Verisk and Protectif.

“While the insurer makes the ultimate decision about how much to charge you, the different approaches of the screening companies can lead to a different picture of your risk. Verisk, for example, asks you to state the name of your medical condition, while Protectif begins by asking you which medications you’re taking and works backwards from that.

“No particular screening company is necessarily going to deliver a cheaper quote, but if you feel like you’ve hit a brick wall with one, trying another could be worth it.”

Specialist insurers are specifically designed to deal with travellers who may be rejected, heavily loaded or offered limited cover by mainstream providers. And with the cost of holidays already high, shopping around could make the difference between being properly protected and taking a potentially disastrous gamble by travelling without adequate insurance.