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Dr. Robert Pearl
Dr. Robert Pearl Routinely and Consistently Fails to Place Patient Care Issues Topmost in His Patheon of Priorities Oakland, California
3rd of Jul, 2011 by User385598
Dr. Robert Pearl, currently serving as CEO and Executive Director of the Permanente Medical Group, consistently avoids personal involvement in issues critical to the maintenance of patient care excellence. Repeated patient appeals to his Office for relief from unhelpful local policies go unanswered. Silence and delegated punitive retaliations by underlings seems to be Dr. Pearl's modus operandi. As such, Dr. Pearl is perpetuating an atrophying of patient care excellence which began some years ago within Kaiser Permanente, when the accumulation of power began to overshadow previous patient care commitments made in more idealistic times. When administrators fail even to share a pleasant word with patients suffering real hardships at the hands of medical personnel serving under them, as a nurse, I feel obliged to attempt to provide a wake up call to those individuals. Thus far, Dr. Pearl has been impervious to patient appeals, preferring rather to hide solemnly behind his title and appointees, rather than leading by example, and personally involving himself in correcting the most blatant abuses taking place on his watch. Recently in Sacramento, in the case of Dr. Susan Scholey, and her persecution of colleagues and patients alike, when Dr. Pearl saw that his Sacramento administrators were not going to handle the situation to prevent further suffering, his office should have intervened. However, the overall impression was that Dr. Pearl purposely exacerbated those situations by ordering a cut off of essential services to patients, even though such cut offs were, if done openly by an individual, blatantly in violation of both federal and state laws. Within the context of an HMO, however, it is difficult to affix blame when patients are made to suffer. This is especially true under the provisions of the Permanente Medical Group's employment contract which seems to essentially prevent any physician from speaking up for patients in the event of serious errors by colleagues. Once an administrator has been informed repeatedly of an abuse, and still there is nothing emanating from his office other than patient retaliations, one has to wonder why such an office exists. It would seem that Dr. Pearl is interested in any issue, so long he does not have to wade into Kaiser medical systems as an advocate for patient care excellence. Perhaps Dr. Pearl considers such work a violation of his dignity. In effect, though, as a physician, we all hope that such work would be first on his agenda always. When it is not, the public is in jeopardy of paying dearly for a service that is more myth than fact. I have yet to witness Dr. Pearl on any occasion intervene on behalf of a suffering patient. Perhaps some day that will happen. We can only hope. However, it certainly didn't happen in the most recent case of elder abuse vis a vis Dr. Susan Scholey, Dr. Robert Midgley, and Dr. Richard Isaacs. And, that is the sad reality.
4621 days ago by Sarabert
Dr. Robert Pearl, several times in public, has admitted that the Permanente Medical Group has failed to provide the level of service for which Members are paying.

That is all well and good, and hopeful. Humility and straightforward admission of imperfection is always attractive.

However, when an executive makes such a statement and then returns to his office and purposely continues to under-serve Members, then we have what is called in law premeditated under-service. That can be a crime.

That is what evidently happened recently when a case of an elderly patient was brought to Pearl's attention.

Dr. Susan Scholey a physician supervisor at South Sacramento had made two recommendations to the elderly patient, both of which were not matters of medical necessity, but simply something Dr. Scholey wanted the patient to do.

When the patient asked for reasons, Dr. Scholey provided reasons that were not based in science, but in personal bias; in other words no reasons relative to the patient's health were involved. It was simply a matter of a physician practicing medicine by fiat.

Well, as was the elderly patient's right, since medical necessity was not involved, and since the recommendations required time resources the patient did not have, the patient simply said "no, " and that's when the trouble began.

As the story goes, the elderly patient had been on a regimen of medications for ten years for a severely compromised skeletal situation. Dr. Scholey simply standing in for the patient's regular physician threatened to cut off these medications, if the elderly patient did not struggle to fulfill requirements that had nothing to do with maintaining his health, since he had been doing well for a decade with his current regimen.

Think about what that means. Let's say you had an angina condition, and had been treated successfully for ten years using a certain medication. Enter Dr. Scholey as temp physician. She orders you to use a skin cream that has nothing to do with maintenance of your health, but if you do not do it, she will cut off your heart medication.

That is precisely the kind of thing Dr. Scholey did, and not only did it, but used certified mail and all sorts of other formal mechanisms to make the patient suffer psychologically along the way.

Just the stress she caused alone would be sufficient to kill many an elderly patient.

And, yet, when this was brought to Robert Pearl's attention, not only did he not do the decent thing and order Scholey to continue the successful regimen, he supported the medication cutoff until the skin cream (symbol only for illustration) was ordered and used.

As absurd as this scenario was, it is the second time in three years that Robert Pearl failed to protect this elderly patient who is now approaching 70. (The last time, the Department of Managed Health Care fined Kaiser Permanente two million dollars. Evidently that didn't impress Pearl at all.)

The last time, one of his subordinates, Dr. Robert Midgley, bailed Pearl out (at least short circuiting criminal charges) by suggesting a physician who would understand that the only thing the patient wanted was consistency, and proof of medical necessity before agreeing to change anything.

This time though, Robert Pearl has evidently ordered everyone to be silent and allow the elderly patient to suffer, if he, the patient, was going to be stubborn and arrogant. After all, we can't have a patient refusing to follow MD recommendations, no matter how bizarre.

It matters not a bit that the patient holds a PhD in mathematics, according to my information. Since he is not in MD "the club, " he better behave or the MD's will see him in his grave to prove a point.

How Robert Pearl can live with himself is the question. Of course, next month, he can always grant another interview and admit that Kaiser Permanente on his watch is really not doing a very good job, and occasionally actually endangers patients on purpose to enforce MD prerogatives.

The assumption after such an admission is that Robert Pearl would be turning over a new leaf, and would be righting the ship in situations like the one above. If that was our assumption, our assumption would be wrong.
4620 days ago by Vincente55
Yes, I agree. I have had dealings with Robert Pearl. I wouldn't have him as my cab driver. A really empty suit who has had way too many privileges in his life, so much so that every day his only question is how things will inconvenience his personal world. Patient care is far down his list of priorities. This is a sad person, a person who needs to be very far away from anyone who is ill.
4619 days ago by Pavlovachicago
My files tell me that Bob Pearl is very smart, but has never really learned how to lead well. Good doctor who needs to be a doctor only, or needs to do his job when he hears that any of the physicians, no matter where they are in his organization, are kicking patients around their offices.

Rule by fiat in medicine is not attractive, since it is usually the patient who knows more about what he or she needs than the doctor does.

With the internet today giving patients a lot of the information that their doctors used to have exclusively, and the patient being able to research very specifically "where it hurts, " doctors are going to need to become listeners instead of lord almighty experts, which they really aren't, given how complex medicine and the human body are.

Most of the time, if a doctor will allow nature to heal that is all that is required, other than doing whatever they can to make patients feel comfortable.

Where nature doesn't heal, body mechanics sometimes can do some good. But, beyond that, as soon as a doctor loses humility as is the case in the report I received regarding Dr. Susan Scholey, physicians become detractors rather than supporters of a better community.

Either a doctor administrator like Pearl is strong enough and interested enough to help a patient in trouble with an abusive doctor like Scholey, or he needs to vacate his office.
4619 days ago by LillyA
Let me share with you a real experience I had with Kaiser Permanente that may shed some light on Dr. Pearl's behavior.

It is true that he could have been so much more proactive, and there is no excuse that he wasn't.

However, in my case, when I had a "Kaiser" problem, as soon as it was escalated any distance at all up the chain of command, I received a contact from an attorney ordering me not to contact anyone further at Kaiser to solve my problem.

In other words, the attorney wanted me not to contact the very people who had the power to solve the problem.

Lucky for me, I ignored the attorney. He kept threatening me, if I didn't stop trying to solve the problem, and I kept ignoring him.

Finally, I found a fellow working in the chain of command with a heart, and the problem was solved.

My point here is that I think a lot of the problems created at Kaiser Permanente are due to bad advice from lawyers.

They really don't want to solve the problems, especially if they are paid on a billable hour basis as this attorney mentioned above was. I know that because he worked for a private firm under contract with Kaiser.

That is what is called a HUGE conflict of interest.

So, in this case, as soon as Dr. Pearl refused to take care of the problem at his level, and as soon as a contract attorney was consulted, this whole situation was lost, IF the chain of command wasn't strong enough to tell the lawyer to go to hell, which evidently they weren't.

No longer was an amicable solution possible, since the attorney's advice would almost certainly have been to be silent and let the problem fester.

I can still remember this lawyer threatening me over and over again about not trying to solve the problem out of court. It was such an evil message, and I think we have lots of that in America.

I am a Japanese citizen, and have relatives in Japan. They were thinking about expanding their law schools a while back, and the reason that was defeated was that they didn't want to have lawyers ruining their culture as they do in the United States.

How many speeches I heard in Japan saying things like, "Do you want to be like the United States with greedy lawyers by the millions trying to stir up trouble." Of course, the people of Japan didn't want that. (By comparison, the US has one lawyer for every 265 citizens. Japan has one lawyer for every 10, 000 citizens. And, every lawyer in American thinks he or she should be rich. What a mess lawyers have made of this Country.)

So what I am saying is that Dr. Pearl probably had a chance to solve the problem early on, but, after a short while, Kaiser contract lawyers would have simply told everyone who had taken the Hippocratic Oath to shut off communication.

Of course, that's the worst possible advice. It just begs for more conflict when one side is being given terrible advice. But there it is. Failing to communicate with a person who is suffering is just asking for that person to become both very angry and very frustrated.

You want to take a shot at real evil, I can give you the name of the Firm representing Kaiser that, had I listened to them, we would probably still be in court. As it was, the problem was solved at the physician level, where it should have been all along.
4618 days ago by LeoneP
Robert Pearl has personal characteristics that work both for and against him.

For example, Robert Pearl, for a CEO, is humble. That's a good thing. But, Robert Pearl's humility is a terrible characteristic when aggression is needed to correct a problem, as in the case of a strong willed physician like Dr. Susan Scholey.

Robert Pearl is loyal to his company. However, that loyalty overshadows the Hippocratic Oath if there is a choice to be made between the company and the welfare of a patient.

Robert Pearl believes in keeping his word. However, the employment contract he signed and his doctors must sign is a patently evil document. It may be legal to suppress information that would help a patient become whole again, and to do it in the name of confidentiality. But it is evil just the same. In any other situation, it would be considered an obstruction of justice. (Lawyers ride herd over this phase of Permanente business, and it shows.)

So, Robert Pearl is in many ways an honorable man. It is just that he should never be placed in a position whereby he has to sign a document like the Permanente employment contract or be counted upon to discipline a strong personality on his watch. That's just not who Robert Pearl is.

On the other hand, if the physician is of a milder disposition, that is, a vulnerable personality, Robert Pearl sometimes is willing to strike. Unfortunately, in those situations, he relies on more aggressive personalities to coach him. This kind of activity tends to prove rather than refute the rule.

On some level, Robert Pearl obeys the primitive pecking order of the species. His MD places him high in that order, so long as he is not swimming in a pool of other doctors. In that pool, Robert Pearl, in terms of viciousness is, to his credit, somewhere near the bottom. But, to attempt to function as a CEO at the bottom of a pool of arrogance is to create problems for both patients and other physicians who are themselves victims of medical barracudas.

This latest round with Dr. Susan Scholey is just one more example of Robert Pearl needing to return to simply practicing medicine, leaving the disciplining of aggressive physicians to others.

Of course, on some level, it is convenient for a Board to have a compliant CEO. I have no idea how that dynamic and interface plays out.

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