The California Medical Association wants the state's managed care chief to step in and obtain medical records for patients treated by KPC-affiliated physicians, something the CMA claims doctors have been unable to do.
In a letter dated Jan. 26, CMA President Marie Kuffner asked the California Department of Managed Health Care to address what she calls the "blatant disregard of patient rights to access medical records."
KPC closed Nov. 21 and filed for bankruptcy days later.
Despite repeated requests, health plan officials have refused to get medical records to patients, Kuffner writes in her letter. "These requests have fallen on deaf ears."
Health plan officials contend they don't own the medical records and aren't responsible for getting them to physicians and their patients. However, the health plans have made considerable effort to get records to patients and absorbed the costs of doing so, says Walter Zelman, president and CEO of the California Association of Health Plans.
He says health plans have paid for copying patient records and have tried to intervene to get those records from KPC offices.
California law states that medical groups and physicians own the medical records. Patients have a right to review those records but do not own them. An expert with the Federation of State Medical Boards says the patients' previous physicians have a legal and ethical responsibility to get those records to patients.
DMHC Director Daniel Zingale says KPC failed patients in "some serious ways." He didn't say how he planned to respond to the CMA's letter. However, he did say all parties involved deserve blame.
"I think we need to expect more from the health plans and medical groups," Zingale says. "There clearly was a lack of responsibility all around . . . The health plans could do much better. I'm not satisfied with the way the major plans conducted themselves overall. I think they can do much better."
CMA officials wholeheartedly agree. But they also believe the state needs to take more steps to get patients their records, says spokesperson Peter Warren. When KPC folded, the group covered about 250,000 patients.
"The failure of KPC should be treated by the state like any natural disaster in terms of dealing with patient care, continuity of care, preservation of records, swift and fast reading and reporting of lab results and tests," Warren says. "If they need to staff offices so patients and doctors can get records, they need to do that. The health plans are not taking care of their responsibility in the face of the bankruptcy."
That's left physicians and patients in the lurch, says Ed Morgan, M.D., a Pasadena, Calif., orthopedic surgeon who oversees a chain of clinics. "We have not gotten any records on any of these patients," he says. "We don't even know how to pursue doing that. The doors are locked. The records are behind those locked doors. . . I'm surprised the plans wouldn't support KPC at least administratively."
KPC's sudden closure created the problem, CAHP's Zelman says. The health plans have gone to "great effort and great expense to get those records," he says. "It has been extremely difficult. The difficulty wasn't caused by anything the health plans did but by the sudden shutdown of a medical facility and the sudden denial of access to the records controlled by the providers associated with the facility.
"To lay this on the health plans boggles my mind," he says.
Had KPC officials acknowledged they were in financial trouble, a transition period could have been arranged, Zelman says.
"I think (the plans) did a great deal," he says. "Whether they might have been more aggressive in pitching a tent outside every KPC clinic, I guess that's open to some question."