A doctor who refused to prescribe patients unnecessary opioids has sued Kaiser Permanente, alleging the way the company used patient satisfaction scores hurt her career and incentivized doctors to over-prescribe painkillers.
Dr. Eryn Alpert worked for Kaiser from 2012 through 2017 and was fired in connection with her critique of the company’s patient evaluation system, the lawsuit alleges. Now she lives in a different state.
“Kaiser’s management denied Dr. Alpert shareholder status at least in part on the basis of financial concerns that advancing Dr. Alpert would result in reduced revenues and that other physicians would follow her example and refuse to prescribe or provide medications that were not medically indicated, further reducing the profitability of Kaiser Permanente’s business operations in the northwest region and nationally,” the complaint alleges.
A spokesperson for Kaiser, which provides medical services across the Puget Sound region and elsewhere, said the company does not comment on ongoing litigation.
Alpert filed her lawsuit Sept. 18 in Pierce County Superior Court.
The complaint, which seeks unspecified damages, gives this account:
Alpert was up for shareholder consideration in 2015. She was denied that status in 2015, 2016 and 2017.
It also was in 2015 that she started saying she thought patient satisfaction scores were “having an adverse effect on patient care and patient safety in the Urgent Care department,” the complaint says.
That had to do with the opioid epidemic, she argued.
“... emergency physicians are faced with a steady stream of patients seeking opioid medications,” Alpert’s complaint says. “When confronted with such patients, it is often not medically appropriate for the emergency department physician to prescribe or administer the requested pain medication, including where the medication may not comply with the course of treatment developed by the patient’s regular physician.”
Some patients retaliate against the doctor by filing complaints and leaving poor reviews.
Alpert’s approach to prescribing such medicine is “cautious and conservative,” the complaint says, and, “Among her Kaiser colleagues, Dr. Alpert was known for refusing to prescribe or administer pain medications unless the medications were medically indicated.”
Her colleagues often went to her to manage patients who wanted opioids.
That led to patient complaints about Alpert by patients denied opioids, and a high standard deviation in her patient satisfaction scores.
A statistician looked at those scores in 2016 and told Kaiser “that the high spread of scores meant that the data was statistically useless to determine the quality of Dr. Alpert’s patient experience,” the lawsuit says.
As Kaiser considered Alpert’s shareholder status, the urgent care department chief highly recommended her and warned that patient scores shouldn’t be used to deny her shareholder status or advancement “since nearly every patient complaint for Dr. Alpert involved patients who had been denied narcotics,” the complaint says.
Alpert also argues that the nexus between patient scores and shareholder status discriminated against pregnant employees.
She took maternity leave in 2016 and alleges her small number of patient surveys that year was used to deny her shareholder status that time.
The way Kaiser used patient scores “systematically incentivized its physician employees (especially its urgent care physicians) to overprescribe opioids to vulnerable populations,” the complaint says. “Kaiser’s system penalized those physicians who refused to prescribe opioids where it was not medically indicated.”
The lawsuit notes that Kaiser profits from prescribing medications to patients.
“Upon information and belief, Kaiser’s business records will substantiate that revenue from Kaiser Permanente’s pharmacy operations is among the most profitable components of Kaiser’s business operations,” the complaint says. “Information from the national database of drug sales maintained by federal Drug Enforcement Administration reveals that Kaiser and Kaiser-related entities operate three of top five pharmacies in Washington state that received the highest number of pain pills between 2006 and 2012.”
Alpert alleges that Kaiser’s motives with the patient scores were financial.
“By requiring its employee physicians to achieve certain patient satisfaction scores in departments where those scores are closely related to a physician’s willingness to prescribe opioids, other addictive medications, and to order unnecessary medical testing (e.g. labs, radiology) in response to patient demand, Kaiser’s intent was to increase its profits so that ... its executives and physicians would receive higher bonus compensation,” the complaint says.
Alpert alleges she repeatedly told Kaiser management about her concerns regarding the patient scores. She was fired in December 2017 in connection to those concerns and her “lack of acceptance of this tool,” the lawsuit says.