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Kaiser and the For Profit Permanente Liver Patient Medical Horror Stories

mirrored here for historical purposes from: http://www.signonsandiego.com/news/metro/20070831-9999-7m31lewis.html

$903,000 awarded to councilman's widow
August 31, 2007
SAN DIEGO – The late San Diego Councilman Charles Lewis was never told by his longtime Kaiser physician Willie Thigpen that he had a serious liver disease and that drinking alcohol would hasten his death, an arbitration judge has ruled.

Charles Lewis - Victim of Kaiser medical denial of diagnosis and treatment
Charles Lewis
The judge, Kevin Midlam, awarded $903,000 to Lewis' widow.

Lewis' “history of seeking medical attention over the years supports the conclusion that had he been better fully informed of his condition, in all probability he would have taken steps, . . . including undergoing a (liver) biopsy, and would have quit drinking,” Midlam wrote in his decision.

The widow, Carlette Lewis, and her attorneys discussed the ruling yesterday with The San Diego Union-Tribune.

“Charles did not know he was sick at all,” Carlette Lewis said. “I'm very happy to finally have my story told, and relieved the judge ruled in my favor. I feel very vindicated. Charles worked hard not only for his constituents in District 4, but for all of San Diego.”
Nonalcoholic steatohepatitis (NASH)

 Affects 2 percent to 5 percent of Americans

 Can occur in people who drink little or no alcohol

 Is preceded by longstanding and excessive fat in the liver, a condition called nonalcoholic fatty liver disease that's more common in overweight and obese people

 Is worsened by alcohol consumption

 Can lead to liver scarring and hardening, much like that seen in longtime alcoholics

 Is usually diagnosed when liver enzyme tests and biopsies show inflammation and significant damage to liver cells

Source: National Institute of Diabetes and Digestive and Kidney Diseases

Lewis was elected to the City Council in 2002 and died Aug. 8, 2004.

He was going through a rough period at the time. Along with fellow Councilmen Ralph Inzunza and Michael Zucchet, he was under federal indictment for allegedly accepting bribes to modify city ordinances dealing with “no touch” strip clubs.

Lewis died before the trial began. Zucchet and Inzunza eventually were convicted of fraud, conspiracy and extortion. Inzunza was sentenced to 21 months in prison and is free on bond pending appeal. A judge acquitted Zucchet, but the government is appealing.

Various documents show that Lewis died due to organ failure after bleeding from a condition in which a severely damaged liver can't process blood, causing the blood to back up in the stomach and esophagus.

The day before his death, Lewis, 37, came home ill after attending a Morse High School reunion picnic at Mission Bay. He was rushed to Kaiser early the next morning after his wife reported he was vomiting blood.

Lewis also had vomited blood three weeks earlier, but told people it was cranberry juice.

Midlam agreed with physicians who testified during a 10-day hearing that Lewis unknowingly suffered from nonalcoholic steatohepatitis, or NASH.

The disease can lead to liver scarring, or cirrhosis, similar to that seen in alcoholics who drink much larger quantities of alcohol for much longer periods of time. Lewis was too young and didn't drink enough to fit the behavior of an alcoholic, the physicians testified.

Health providers nationwide have said they're increasingly finding NASH in overweight people.

Lewis was “a model for a person” for developing NASH, Midlam wrote. “He was African-American, borderline morbidly obese, with high cholesterol and borderline anemia,” Midlam added.

Lewis made more than 50 visits to Thigpen and other Kaiser doctors over several years, went to the emergency room six times, underwent one surgery and logged 28 trips to laboratories for tests, his wife's attorneys said.

Thigpen never referred Lewis to a liver specialist even though his patient had numerous warning signs, such as rectal bleeding, nose bleeds, stomach cramps and elevated cholesterol levels.

Robert Coffin, one of Carlette Lewis' attorneys, said he believes Thigpen never took the time to pull all of Charles Lewis' test results, imaging studies and physical exams to correctly diagnose the patient.

“There were all these red flags that Mr. Lewis had something dramatically wrong with him,” Coffin said. “But he just fell through the cracks.”

Eight months before Lewis' death, a sonogram showed his liver had become dangerously enlarged, yet he was never told about it, Midlam wrote. Thigpen never ordered a biopsy, which would have confirmed NASH, the judge added.

Instead, Thigpen referred Lewis to an endocrinologist for a potential thyroid problem two months before he died, Lewis' medical records show.

While the judge ruled in favor of Carlette Lewis' claim, he also faulted the councilman. Midlam said Lewis did not seek medical attention when he vomited blood several weeks before his death and that for a while, he was not candid with his medical providers about an increase in his alcohol consumption.

Because of those factors, the judge reduced the economic-damage portion of Carlette Lewis' award from $1.3 million to $653,000. Midlam also gave her $250,000 for non-economic damages.

“Mr. Lewis should bear a 50 percent proportionate share of the responsibility for his unfortunate and untimely demise,” the judge wrote. “(Mr. Lewis) was very concerned about his position in the community and reticent to admit he may be abusing alcohol.”

The strip-clubs case caused a lot of stress for Lewis, his wife said.

While friends and colleagues testified that Lewis was highly functional and not an excessive drinker, Lewis told Kaiser caregivers shortly before his death that he had been drinking more than he previously acknowledged.

A member of Lewis' staff was said to have bought cases of Long Island iced tea, a cocktail with high alcohol content, on “at least a bimonthly basis,” Midlam wrote.

In setting the award amount, the judge also considered the indictment against Lewis.

“The weight of the evidence is that Mr. Lewis would have been convicted of part or all of the criminal charges against him and that the conviction would have been upheld on appeal,” Midlam wrote.

Midlam exonerated Kaiser Foundation Hospitals, Kaiser Foundation Health Plan Inc. and Southern California Permanente Medical Group, which also were named as defendants.

Because Kaiser covers medical malpractice claims against its physicians, it will pay the $903,000 to Carlette Lewis, said Kaiser spokesman Rodger Dougherty.

Thigpen has retired from Kaiser and moved to Louisiana. He could not be reached for comment.

Kaiser attorney Barton Hegeler said he disagreed with Midlam's conclusion, adding that Thigpen had many conversations with Lewis about his medical condition and his use of alcohol.

“Unfortunately, not all of the advice Dr. Thigpen gave Mr. Lewis was documented,” Hegeler said.

Under Kaiser's rules, lawsuits against its health system are settled through arbitration and judges' decisions cannot be appealed.