Cedar Sinai airs dispute with Kaiser Permanente

By Paul Haist

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Cedar Sinai Park Chief Executive Officer David Fuks is going public with his disappointment over service provided to one of its residents by Kaiser Permanente in Portland, and what Fuks believes is Kaiser's unresponsiveness.
Cedar Sinai Park is the Jewish senior living campus in Southwest Portland that provides a range of services to seniors and other infirm through the Robison Jewish Health Center, a nursing home, and Rose Schnitzer Manor, a residential community that provides varying levels of support to its residents.
Fuks' disappointment arose out of circumstances more than a year ago when an Orthodox Jewish man residing at the Robison Jewish Health Center needed to be hospitalized and was taken to the Oregon Health Sciences University for hospital care that could not be provided by Robison. Kaiser Permanente contracts with OHSU, among other institutions, for such service.
After the man's hospitalization, Kaiser transferred him to a non-Jewish facility.
In an open letter to then Portland Kaiser CEO Cynthia Finter, Fuks explained:

Unfortunately, after he was hospitalized during a period of illness that was a precursor to the end of his life, Kaiser denied our resident the opportunity to return to the facility where he resided for care. He could not spend his fragile remaining days in a setting where his spiritual, social and emotional needs would be taken into account.
We were deeply disappointed that, while in care under your supervision at another facility, he was served bacon during a meal. To most people this would perhaps be perceived as a minor mistake, but to a religious Jew this was a spiritual insult, which put him in a position of either going without food or potentially violating a commandment.
From such a perspective, the presence of the bacon makes all of the food unkosher and creates a level of anxiety and distress that is hard to understand outside of the cultural context of the individual being served.
Fuks said he was making the issue public because Kaiser's response to date failed to adequately address the issue. He said that Kaiser had become "unresponsive."
"At first, your staff were very cooperative and assured us that steps would be taken to find a solution to this problem," Fuks wrote.
Then, after a planned meeting between CSP and Kaiser was first postponed and then canceled by Kaiser, Kaiser informed CSP that the HMO could not accommodate everyone's dietary needs, according to Fuks.
"Being left with no recourse for internal communication with you, we are communicating our concern publicly in the hopes that we might motivate a more appropriate consideration," Fuks advised Kaiser's CEO.
In critiquing Kaiser's response to this incident, Fuks challenged the HMO's perspective, both on the matter of diet and not allowing the patient to be returned to Robison.
Where Fuks believed Kaiser's understanding of the complaint was solely an issue of dietary preference, he wrote, "This is incorrect. Keeping kosher is a religiously motivated behavior with its roots in the Bible. Observant Jews adhere to this requirement in an attempt to make even the mundane act of eating sacred."
Bradford G. Brokaw is Kaiser Permanente's spokesman in Portland. He told the Jewish Review on July 19, "We recognize this issue is more than just a dietary one and realize that healing involves more than just a physical aspect alone. We understand that this incident could have been construed as an insult to the patient, his family, and the Jewish community."
He added, "We are taking immediate action to ensure that kosher meals are served to patients on request in every Kaiser Permanente-contracted facility."
On the matter of not returning the patient to Robison where his Jewish cultural, spiritual and religious needs could be addressed, Brokaw said, "When you have a person who is, quite candidly, in the last stages of his life, where there is severe illness, we send (them) to places where we can better manage the care."
He said several factors influence the decision on where to send the patient, including space availability, Kaiser's ability to control the quality of care in a particular location and cost.
"In retrospect, had we to do it all over again," said Brokaw, "I think we would have tried to move heaven and earth to get this man to Robison."
That remark pleased Fuks, who said, "I hope that in the future they will consider that prospectively," meaning before a problem arises.
"We hope that Kaiser will honor and respect the special needs of members of our community and particularly be responsive to patients who already live on the (CSP) campus," he added. "As far as we could tell in this case, they simply didn't think about it and followed their standard procedure, which seems reasonable to facilitate their physicians' ability to follow patients, but without considering the needs of the patient."
Brokaw acknowledged that Kaiser has "to figure out a way to have a better relationship with Robison."
He said that Kaiser can't "enter into a hard and fast contract," with Robison because "he (Fuks) has been very clear about his inability to take non-Jewish patients" from Kaiser.
Fuks disputed the point.
"We are certainly able to take non-Jewish patients, but Kaiser was asking us to take up to 15 non-Jewish patients, which was too many, because it could negatively impact our ability to be responsive to the needs of members of the Jewish community," said Fuks. "If we fill up all of our discretionary and flexible capacity with Kaiser patients, we may not be able to respond to needs of our community."
Brokaw said he understood Fuks' point.
"It would dramatically change the culture of the facility ? you're talking about diminishing the reason for its existence," said Brokaw.
Fuks suggested alternatives, such as contracting for a smaller number of Kaiser patients, which he thought Kaiser would not agree to, or to contract on an individual basis.
"We would be willing to work with Kaiser around issues of cost and efforts to optimize patient care so that they would be satisfied," he said. "Certainly, in terms of quality of care, they're not going to find a better facility than what we've got and they know that."
He said that airing the issue in the media was unusual, "but if that becomes a tool to create face-to-face contact, well, that's all we're asking for."
An Aug. 16 meeting now has been set between representatives from Kaiser, Cedar Sinia Park and the Jewish Federation of Greater Portland.