Kaiser doctor, accused of negligence, remains
on the job
By Tracy Weber and Charles Ornstein
Los Angeles Times

Late one April night, the first of Sarah Valenzuela’s twins arrived with little
trouble, but the second stayed put.

Though the baby was not in distress, Kaiser Permanente
perinatologist Hamid Safari attached a vacuum extractor to the
boy’s head to draw him out. Again and again he tugged, but still
the baby would not come.

He vigorously shook the vacuum, up and down, side
to side, according to government documents and
hospital incident reports.

It took 90 minutes and six tries — the last with
Safari on his knees, pulling. Horrified staffers — and
the boy’s father — looked on as baby Devin finally
emerged. His skin was a bloodless white, his neck
elongated and floppy.

His spinal cord had been severed.

Safari lashed out at a nurse. “What did you do to that baby? I gave you a
good baby,” he said, according to a complaint letter the nurse sent to her
union representative.

Staffers at the Fresno birthing center were devastated and angry — and
not just because of the twin lost that night in 2005.

Over the years, doctors and nurses repeatedly had complained to higher-
ups — including Kaiser’s top medical officer in Northern and Central
California — about problems they saw in Safari’s skills and behavior,
according to interviews and documents.

This is a story not just of tragic medical outcomes, but of a health plan
that did not prevent them.

A year before Devin’s death, the doctor had waited more than three
hours to do a Caesarean section even though the baby girl was in
distress and her family said they had been pleading for the procedure,
according to interviews and government records. She was severely
deprived of oxygen and died months later.

As far back as 2002, a physician review committee at the hospital
concluded that Safari provided “inappropriate” care and that his “conduct
needed significant improvement,” according to a lawsuit later filed by two
of his peers.

Still, the doctor continues to work at Kaiser Fresno, practicing under
restrictions that staffers say have not been explained to patients.

Regulators acted only recently. This July, the state Department of
Managed Health Care fined Kaiser a record $3 million for its haphazard
handling of complaints and physician errors throughout the state.
Officials said in an interview that the Safari matter played a significant
role in their decision to investigate the HMO’s practices.

Late last month, the state medical board accused Safari of gross
negligence, seeking to revoke or suspend his license.

The board also has faulted Kaiser, the nation’s largest HMO with 6.5
million members in California. The health plan made the board’s
investigation of Safari “protracted and difficult” by providing incomplete
medical records, a spokeswoman said.

Kaiser did not allow senior officials to be interviewed for this story — and
warned staffers at Kaiser Fresno not to talk, several said. In a statement,
hospital administrator Susan Ryan said the HMO has cooperated with the
medical board and is “committed to ensuring the safety of our patients.”

In July 2005 — three months after Devin’s death — Kaiser imposed its
restrictions on Safari, barring him from performing vaginal deliveries and
requiring him to be monitored by another physician or an advanced-
practice nurse, Ryan said. The restrictions became permanent in April
2007. Kaiser and other hospitals typically do not notify patients of such
actions, officials said.

Safari, 49, declined to comment. His lawyer, Stephen D. Schear, said the
accusations are “completely unwarranted” and that Safari intends to
challenge the medical board’s action in a hearing. Safari, he said, has
the support of many at the hospital and in his department.

“If you’re doing thousands of high-risk deliveries over the years, it’s
almost inevitable that there’s going to be some unfortunate cases where
children die, where things don’t go right,” Schear said.

“You’re talking about one minute maybe where he pulled too hard to try
to extract this baby. . . . Just look at his whole record, 10 years.”

But doctors and other staffers allege that Devin’s death was the
culmination of Safari’s troubles, not a fluke.

“We do not feel that our perinatologist is competent,” reads an August
2005 petition signed by eight of Safari’s peers, about half of the ob-gyn
department. “Over and over again he put our patients at risks and most
recently with the undeniably terrible outcome.”

Kaiser was “misleading our patients and the public” by advertising that it
had a perinatalogist on staff even though his practice was restricted, said
the petition, which was addressed to the hospital’s medical director.

The petition, complaint letters, depositions and other documents used in
preparation of this story are part of the ongoing lawsuit by the two
doctors and arbitration cases against Kaiser, or have been provided to
state regulators investigating Kaiser and Safari.

Dr. Gilbert Moran, one of the doctors who sued Kaiser and its
affiliated Permanente Medical Group, alleges that they punished
him and others who complained, rather than address their
legitimate concerns.

“I’ve been telling these guys for years that he was going to kill someone,”
said Moran, the former ob-gyn chief. “And no one would listen.”
Misjudgments, mistakes

In 1997, Kaiser’s Fresno hospital needed more obstetricians but was
having difficulty finding specialists willing to live and work in the Central

A staff physician recommended Safari, a former classmate from the
Tehran University Faculty of Medicine in Iran, who had just completed a
fellowship in perinatology at Los Angeles County-USC Medical Center.
That training qualified him to treat high-risk pregnant women.

Without its own perinatologist, Kaiser had been forced to send
such women to outside doctors and hospitals, often at enormous

Safari arrived that August. Within months, staff members began to
file complaints to Moran, alleging that Safari was rude and

“Dr. Safari let everybody know in no uncertain terms that since he
was hired as the perinatologist that his intelligence level
exceeded everybody’s,” said a nurse who, like several other
staffers, insisted on anonymity because she feared for her job.

As time went by, staffers allege, they began to notice that the specialist
also was making misjudgments and mistakes.

But Safari resisted criticism, they said. After the ob-gyn
department’s quality committee ordered him to work on his
deficiencies in 2002, Safari “adamantly refused to follow the
committee’s plan, stating that general OBGYN’s cannot tell a
specialist, perinatologist, what to do,” according to a pending
lawsuit filed in May by Moran and a colleague, Dr. Robert Rusche.

The suit does not name Safari as a defendant but seeks damages from
Kaiser and the Permanente Medical Group, alleging the HMO retaliated
against them for drawing attention to Safari. In court papers, the
defendants have denied the allegations.

The hospital called in Kaiser’s regional chief of perinatology, who
reviewed Safari’s charts and sided with the committee, the suit

One of the cases involved a woman with possible pre-eclampsia —
characterized by high blood pressure and swelling that can lead to
serious complications, according to Schear, Safari’s attorney. A review by
physician peers found that she should have been hospitalized, he said.
In a second case, they cited Safari’s failure to detect a potentially risky
condition in which twins had markedly different weights, he said.

The review process was driven by Safari’s enemies, principally Moran,
and the cases cited did not involve harm to patients, Schear said. Even
so, Safari followed the committee’s instructions, he said.

“Peer review can be used in an unfair way to go after a doctor that
people want to go after,” he said. “No doctor is perfect.”

Some of Safari’s colleagues agreed.

“Dr. Safari has been scrutinized way beyond what a person in similar
circumstances would have happen to them,” said Dr. Thomas Kulterman,
a Safari supporter.

Moran said Safari’s performance made him a target, and it did not
improve with time or scrutiny.

Repeatedly during 2002 and 2003, Moran and Rusche complained
to Dr. Varoujan Altebarmakian, the hospital’s chief physician, and
others that Safari’s “unsafe” treatment of patients “clearly fell
below any accepted standard of care,” according to the doctors’

Altebarmakian told them the situation “would be taken care of,” the suit

Little need to question

Tanella Bessard knew nothing about Safari when she first saw him in
October 2003.

She had grown up under the HMO’s care. Her children were born at
Kaiser hospitals, the second with a congenital heart defect. So when
Bessard became pregnant with her third child, she heeded her Kaiser
doctor’sadvice to consult Safari, the hospital’s sole perinatalogist.

In mid-January, when she was about 32 weeks pregnant, Bessard was
hospitalized for early contractions. Safari ordered shots to halt the labor
and other steroid injections to develop her baby’s lungs, then allowed her
to return to work, she said.

“I didn’t have a lot of reason to question him,” said Bessard, now
33. “He seemed to stay in tune with me and what my concerns

On Jan. 28, when the baby was several weeks shy of full term, Bessard’s
contractions became unstoppable, according to interviews and
deposition transcripts. She was admitted to the hospital, and by 10 p.m.
Safari noted drops in the baby’s heart rate after the contractions peaked.
Such “late decelerations” can signal a reduced oxygen supply to the
baby and, if prolonged, can cause critical harm.

Bessard’s mother, Lanell Brown, said she was watching the fluctuating
lines on the fetal monitor with growing concern. She and Bessard pushed
Safari to do a Caesarean section, but he resisted, they alleged.

Bessard’s baby, Paris, ultimately was delivered by C-section just
past 1 a.m. — more than three hours after the late decelerations
began. By that time, the pH of Paris’ umbilical cord — an indicator
of a baby’s oxygen level before birth — was 6.8.

This level is “almost incompatible with life, it is so bad,” said Dr.
Khalil Tabsh, chief of obstetrics at UCLA’s medical school, who
spoke generally and did not review Bessard’s records. “Babies
that are born with 6.8, they either are dead or they are in deep

In her first months, Paris required oxygen and had seizures. “She
didn’t do the normal things that children would do at her age,”
Brown said. Paris died that November, not yet 10 months old.

The county coroner attributed her death to chronic
bronchitis and bronchiolitis — respiratory diseases
— but did not address whether it was related to
birth trauma.

Bessard filed an arbitration claim, which Kaiser settled for an undisclosed
amount. The HMO requires arbitration in legal disputes, a mandate that
keeps all legal filings and their resolution confidential and out of public

In a deposition reviewed by The Times, Safari testified that it was
Bessard who resisted his recommendation for a C-section.

“He changed everything around,” she said in an interview,
“which really blew me out of the water.”

A financial settlement with Kaiser, reached in October 2005, gave
Bessard little solace, she said. That’s why she asked her lawyer to refer
her allegations to the state medical board.

Nearly two years later, when the board accused Safari of gross
negligence, it cited his failure to do an “immediate Caesarean
section.” Instead, officials said, he waited more than two hours to
call for one and then took “some 50 minutes to deliver the infant.”

Another warning

About the time of the Bessard birth, tensions within the birthing center
were escalating, according to memos and interviews.

In early 2004, Safari’s “behavior became irrational and included
threatening to starve himself, light himself on fire, and to call
CNN to witness his plight,” said Moran’s suit, which refers to
Safari as “Dr. X.”

Schear, Safari’s attorney, said his client never said he would burn
himself, but did threaten to go on a hunger strike to protest harassment
by his boss, Moran. Other physicians complained that Moran played
favorites, he said.

In May 2004, medical director Altebarmakian removed Moran as
ob-gyn chief, citing his arrogance and his department’s
dysfunction in a follow-up letter. At the time of his removal,
Moran contends in his suit,
he warned Altebarmakian
that if something wasn’t done, Safari “would again
permanently harm one of Kaiser’s patients.”

In December of that year, Moran had his meeting with Dr. Robbie
Pearl, Permanente’s top physician for Northern and Central
California, to discuss
Moran’s concerns about Altebarmakian.
According to his notes made at the time, Moran said he warned
Pearl about Safari, and Pearl said he was “well aware” of the
situation, including Safari’s threats to harm himself.

Devin, the twin boy, died in the delivery room four months later,
and the case is now key to the medical board’s complaint against

Tabsh, UCLA’s obstetric chief, said that in his 35 years of practice
he’d never heard of a full-term baby’s spinal cord being severed
during a vacuum procedure.

“Everybody that was involved in it was literally sick,” said one nurse, who
also spoke on condition of anonymity. “She was begging for a C-section.”

Another nurse, the one allegedly blamed by Safari for Devin’s
death, questioned why no one had investigated whether Safari
was threatening his colleagues. In her July 2005 letter of concern
given to her union representative, she described him as
repeatedly “harassing” her about the event.

“Those of us who did the right thing and came forward to speak up
against Dr. Safari when he was in the wrong feel very threatened,” the
veteran nurse wrote.

Schear said Safari threatened no one and had safely performed about
200 vacuum deliveries.

“It stinks. It just stinks. You’re looking at one minute of this guy’s career
and you’re going to cream him. It’s very dramatic-sounding, ‘Oh, the poor
baby broke his neck.’ It’s not something where you want to destroy a
good and excellent perinatalogist’s reputation.”

Today, Valenzuela and her husband, Randy Ramirez, both 37, decline to
say much about what happened. Valenzuela said she can’t discuss her
arbitration settlement, and that they are afraid talking about Devin will
make life unbearable again.

“Words can’t even describe it,” Ramirez said.

Sarah’s sister, Helen Valenzuela, recalled that Sarah “cried for a year”
after Devin’s death.

Helen still remembers a nurse emerging from the delivery room, crying.
Later, she said, she confronted Safari in the hallway: “You
murdered my nephew!”

“He told me to ‘Calm down, or we’re going to have you removed,’
” she said.

Near dawn, hours after Devin’s death, Helen said she was in the room
when Safari sat on the side of Sarah’s bed and unburdened himself.

” ‘Nothing like this has ever happened to me before,’ ” she
recalled him saying.

Futile to complain

As staffers traded details about the case, Moran and Rusche
recall wondering why it hadn’t been promptly discussed by the
hospital’s ob-gyn quality review committee — a practice they
called routine in serious cases.

The doctors separately looked at Valenzuela’s medical records and
Rusche brought his concerns to his supervisors.

In July, hospital officials took action by limiting Safari’s scope of practice.
But they also took aim at the messengers, Moran and Rusche, for
violating patient privacy restrictions by reviewing the records.

Moran was suspended for two weeks without pay, had his salary cut by
$20,000 a year and was denied a year-end bonus, while Rusche was
suspended for one week without pay and denied a bonus, according to
their disciplinary letters.

Both men challenged the discipline but got nowhere, their suit alleges. It
was their right to view the records, they contend, as quality committee
members. And Moran said he had treated Valenzuela after her delivery.

In the months that followed, the hospital administration chastised
the eight obstetricians who submitted the petition warning
administrators about Safari in August 2005.In a staff memo,
Altebarmakian wrote that a petition “targeting an individual
practitioner is counterproductive and discourages the
cooperative, harmonious and respectful work environment that
the medical group expects and encourages.”

Several staffers began to sense that it was futile —
not to mention risky — to complain.

“It looks like nothing changes,” said one veteran nurse. “I don’t
know who protected him. I don’t know who came to bat for him.
But he’s still there.”

Rusche recalls the moment he decided he’d had enough. A new
patient had come in, and Rusche deemed her high-risk — a
decision that ensured she would be sent to Safari.

“To me, I had crossed the line there,” he said. “It all of a sudden hit me
what the heck I had just done.”

In January 2006, he and Moran gave up on resolving matters internally.
They took their complaints to the medical board, just as Bessard’s lawyer
had done earlier.

Rusche retired last year and has traveled the country in a motor home.

Moran now works for Kaiser in Bakersfield, 100 miles from his
home, and sees his family on his days off.

Safari is a “really good physician” with a lengthy track record of doing
“very difficult deliveries,” said Dr. Daryoush Razi, a fellow student from
the Tehran medical school who now heads the ob-gyn department’s
quality committee. “I trust him with treating my family.”

Earlier this year, he and 10 other doctors signed a letter of support for
Safari. Several were new to the department, but three had apparently
changed their minds after signing the protest petition in 2005.

He is “an asset to our department,” the letter said.

Blog posts re Hamid Safari
Thank Heaven for
Insurance Companies blog
Cases and news
Blog: Kaiser Permanente
Kaiser Permanente links
Kaiser Permanente's handling of the Dr. Hamid
Safari case

“I’ve been telling these guys for years that he was going to
kill someone,” said Dr. Gilbert Moran, the former ob-gyn chief.
“And no one would listen.”
Doctor who complained about Hamid Safari is
fired by Kaiser

Do you want to know if your doctor is likely to kill you?  Do you want
such a doctor fired?  Sorry, these things would violate the doctor's
rights, and the rights of Kaiser Permanente.

California courts agree that it's okay for Kaiser Permanente to fire a
doctor for complaining that another doctor was a threat to patients.  
The courts also agree that it's okay for a Kaiser doctor (Hamid Safari)
to keep his license after severing a baby's spinal cord because the
baby wouldn't come out of his mother's womb fast enough (even
though the baby was in no distress when the doctor started yanking
him out).  Who was the victim here?  It was poor Dr. Safari.  "Nothing
like this has ever
happened to me before," he said when the baby
died.  He threatened to go on a hunger strike because he was being





Real Parties in Interest.

No. F061801.
Court of Appeals of California, Fifth District.
Filed November 16, 2011.

Matthews Law Group, Charles T. Mathews; The Rager Law Firm, Jeffrey A. Rager; Law
Offices of Roxanne Huddleston and Roxanne Huddleston for Petitioner.

[Kaiser's lawyers:] Paul, Hastings, Janofsky & Walker, James A. Zapp, Ryan J. Crain;
McCormick Barstow, David R. McNamara and Scott M. Reddie for Real Parties in Interst.


Petitioner seeks a writ of mandate directing the trial court to vacate its order
granting real parties' motion to compel arbitration and to enter a new order
denying the motion.

Petitioner contends the arbitration agreement is fatally ambiguous,
does not meet the minimum standards of fairness established by
Armendariz v. Foundation Health Psychcare Services, Inc. (2000) 24
Cal.4th 83 (Armendariz), and is substantively and procedurally
unconscionable. We conclude that the arbitration agreement is valid
and enforceable, and deny the petition.


Petitioner filed a complaint against The Permanente Medical Group (TPMG)
and real parties in interest, Kaiser Foundation Health Plan (KFHP), Kaiser
Foundation Hospitals (KFH), and Southern California Permanente Medical
Group (SCPMG).
KFHP sells prepaid health care plans to its members.
It provides medical services to its members by contracting with two
groups: SCPMG in southern California and TPMG in northern
California. SCPMG and TPMG are physician owned entities. KFH
provides or arranges for hospital services for KFHP members.
complaint alleged petitioner was employed by real parties and TPMG until his
employment was terminated effective February 22, 2010. It included causes
of action for wrongful or retaliatory termination, violation of the Fair
Employment and Housing Act (FEHA; Gov. Code, § 12940 et seq.) based on
race or national origin discrimination, defamation, intentional interference
with prospective economic advantage, and intentional infliction of emotional

The complaint alleges petitioner was employed by TPMG, KFH, and KFHP as
an obstetrician and gynecologist at a Kaiser facility in Fresno.
2002 and 2004, while he was Chief of the OB/GYN department and
oversaw the quality of care committee, petitioner complained to
hospital officials about substandard patient care given by a doctor
identified as Dr. X. The physician-in-chief told petitioner to stop
complaining, and dismantled the quality of care committee; he
demoted and otherwise disciplined petitioner as a result of the
complaints. Dr. X's negligence resulted in the death of three
patients. Petitioner was told he could work harassment-free at
Kaiser-Bakersfield if he resigned his partnership, returned to
employee status, and accepted a reduction in pay and job security;
he was told he would likely be promoted to partnership again after
one year, rather than the usual three years.
Petitioner agreed to this.
His first day of work for SCPMG in Bakersfield was January 8, 2007. He
subsequently filed a lawsuit alleging retaliation for patient advocacy; that suit
was resolved on June 29, 2009. Petitioner was later told he would not be
promoted to partner at Kaiser-Bakersfield; he was terminated effective
February 22, 2010.

Real parties responded to petitioner's complaint in the underlying action by
filing a motion to stay the action and to compel arbitration of all of petitioner's
claims against them pursuant to his employment agreement with SCPMG.
TPMG filed its own motion to stay the action and compel arbitration, pursuant
to the same employment agreement. Real parties presented the employment
contract between SCPMG and petitioner and the arbitration agreement it
included. SCPMG had submitted three proposed contracts to petitioner
electronically through its website. Each contained section XII, which stated:
"Physician and SCPMG agree to be bound by the attached Arbitration
Agreement, which is incorporated by reference into this Contract.

Furthermore, except to the extent that such would conflict with the attached
Arbitration Agreement, Physician and SCPMG agree to follow the Dispute
Resolution Procedure (Rules and Regulations, section 1I) or Alternative
Dispute Resolution Procedure (Rules and Regulations, section 1J)." When
petitioner accessed the website to review the employment contract, the
website had links to other employment-related documents, including the
Rules and Regulations, which contained the Dispute Resolution Procedure
(DRP), which in turn contained the provisions for arbitration of disputes.
Petitioner electronically signed the third employment contract on December
30, 2006. On January 8, 2007, his first day of employment with SCPMG,
petitioner received a copy of the DRP and signed a document acknowledging
he had received it, read it, and agreed to abide by it; he declared he was told
he had to sign it or he could not work there.

In their motion to compel arbitration, real parties contended that all of
petitioner's claims arose out of his employment with SCPMG and, because
petitioner alleged KFH and KFHP were acting with SCPMG as a single or joint
employer, or alter egos or agents of one another, his claims against all three
were subject to binding arbitration. TPMG also asserted it had standing to
compel arbitration because petitioner alleged TPMG was a joint employer,
alter ego, or agent of SCPMG. Petitioner opposed the motions, arguing
KFHP, KFH, and TPMG were not parties to the arbitration agreement and
denied being agents or joint employers of petitioner, so they had no standing
to compel arbitration. He also asserted the arbitration agreement, if it existed,
was unconscionable and should not be enforced.

The trial court issued a tentative ruling denying the motions. It reasoned the
employment agreement containing the arbitration agreement was between
petitioner and SCPMG, and the other defendants denied having an agency
relationship with SCPMG; accordingly, the authorities allowing agents to
obtain the benefit of the principal's arbitration agreement did not apply. It
opined there was also a possibility of conflicting rulings on common issues of
law or fact if the claims were split between arbitration and litigation. After
further briefing and oral argument, however, the court granted the motion as
to SCPMG, KFH, and KFHP. As to TPMG, it denied the motion and severed
the sixth cause of action.1 Petitioner filed his petition with this court, seeking
a writ of mandate directing the trial court to vacate its order granting real
parties' motion to compel arbitration and to enter a new order denying the
motion. We issued an order to show cause why the requested relief should
not be granted, in order to consider the questions raised.


I. Writ Review

A writ of mandate "must be issued in all cases where there is not a plain,
speedy, and adequate remedy, in the ordinary course of law." (Code Civ.
Proc., § 1086.)2 Writ review is deemed extraordinary, but may be granted
when "`the party seeking the writ lacks an adequate means, such as a direct
appeal, by which to attain relief' or `the petitioner will suffer harm or prejudice
in a manner that cannot be corrected on appeal.' [Citation.]" (City of Half
Moon Bay v. Superior Court (2003) 106 Cal.App.4th 795, 803 (Half Moon
Bay); Science Applications Internat. Corp. v. Superior Court (1995) 39
Cal.App.4th 1095, 1100 (Science Applications).) An order granting a petition
to compel arbitration is not immediately appealable. (State Farm Fire & Cas.
v. Hardin (1989) 211 Cal.App.3d 501, 506.) In the absence of writ review,
petitioner will be required to comply with the order in full, arbitrating the
claims against real parties and litigating the claims against TPMG, until final
judgment is entered; only then will he be able to seek review by appeal. By
the time the matter is arbitrated and litigated to judgment, petitioner will have
incurred the expenses of both arbitration and litigation; he will not be able to
effectively challenge the order and avoid that expense. Accordingly, we
conclude petitioner does not have "a plain, speedy, and adequate remedy, in
the ordinary course of law" and review by extraordinary writ proceeding is
appropriate in this case. (§ 1086.)

II. Existence of Arbitration Agreement...
Surprises at Garfield Center in
Kearny Mesa
San Diego
Education Report
Altebarmakian, MD
2003 Everyday Hero
Urology | Physician-in-Chief Fresno

“I do everything out of love and passion,”
says Varoujan Altebarmakian, MD,
Physician-in-Chief and Urologist at
Kaiser Permanente Fresno.
“With passion, results are always good.”

Dr. Altebarmakian–lovingly nicknamed
Dr. Alte by his co-workers–considers
serving people his life’s mission.
“I feel it is my duty to give to others in need.” Whether conferring with a patient or
colleague, Dr. Alte shows genuine concern for their well-being. Along with his
welcoming bear hugs, Dr. Alte is known for his availability; he invites staff to call him–
no matter the hour–because ‘no question or need is too small’.

“I love people unconditionally,” he says. “If our members receive good care and are
happy, we’ve achieved our goal.”

“He’s the hardest working man I know,” says Corwin Harper, Director of Hospital
Operations and Medical Group Administrator at the Fresno facility. “He’s caring,
compassionate, and committed. He drives for success and excellence–for the
greater good of all, not just for himself.”

Dr. Altebarmakian volunteers tirelessly in the community. His strong spiritual beliefs
have led the Armenian Apostolic Church to name him Chairman of the Western
Diocese–the highest honor it bestows. “When you do something for your community
or church, you understand yourself as well as others better.” Dr. Altebarmakian
elaborates, “Those who give their time and resources are happiest in life.”
Susan Ryan deservedly is forced to resign,
but what about Dr. Robert Pearl and
Dr. Varoujan Altebarmakian?

Fresno Kaiser facility official resigns
A federal report had faulted the hospital for its slow
response to complaints about a physician.
January 29, 2008
Charles Ornstein
Los Angeles Times Staff Writer

The administrator of Kaiser Permanente's Fresno hospital stepped down
Monday, days after the release of a federal report that criticized the way the
medical center responded to complaints about a doctor who handled high-risk

In a written statement released late Monday, Kaiser said Fresno hospital
administrator Susan Ryan had resigned, effective immediately.

Last week, the U.S. Centers for Medicare and Medicaid Services
released a report suggesting that if Kaiser Fresno had kept a closer
watch over its medical staff, two babies might still be alive.

The review was the latest in a series of critical assessments of the giant
health maintenance organization, the nation's largest with 6.5 million members
in California.

The Medicare agency investigated the Fresno hospital after the Los Angeles
Times reported in October that doctors and nurses had complained
repeatedly to higher-ups about perinatologist Hamid Safari's medical and
interpersonal skills.

Rather than address their concerns, staffers told the newspaper, hospital
leaders allowed Safari to continue handling high-risk pregnancies without

Safari allegedly botched at least two deliveries after staff members raised
their concerns. One baby died in the delivery room in April 2005; another died
months after her January 2004 birth. Safari has been accused of gross
negligence by the state medical board; his attorney said he did nothing wrong.

Gregory A. Adams, associate regional president and chief operating
officer of Kaiser Foundation Health Plan and Hospitals in Northern
California, acknowledged in a written statement that the federal
report was "highly critical of the Fresno hospital administration's

"We have reviewed the facts and taken action to address the
leadership issues raised in this report," he wrote.

Last week, in response to the federal report, Ryan defended the
hospital's quality oversight program and said officials had taken
appropriate action after Safari's alleged mishaps.

"When these events occurred, they were thoroughly investigated and
corrective actions were taken," she said in a written statement Friday. "This
has led to significant improvements in our perinatal safety program."

In July 2005, three months after the second baby's death, Kaiser imposed
restrictions on Safari, barring him from performing vaginal deliveries and
requiring him to be monitored by another physician or advanced-practice
nurse. The restrictions became permanent in April 2007, hospital officials said.

Since September, Safari has not performed any surgeries or C-sections and
has served as a consultant at the hospital, Ryan said last week.

Ryan, who
took over in August 2005, was not in charge at the time of the
allegedly problematic deliveries by Safari. But a Kaiser spokesman said that
"the hospital administrator has responsibility and accountability for the
systems and processes in the hospital."

Spokesman Mike Lassiter
declined to say whether the hospital planned
to take action against
Dr. Varoujan Altebarmakian, the
hospital's physician in chief since 1999
, who records show
received numerous complaints about Safari.

Susan Ryan

Board Member--Nov. 2011
Hinds Hospice

January 2011 – Nov. 2011 (11 months)
Chief Operating Officer
Saint Agnes Medical Center

Nonprofit; 1001-5000 employees; Hospital & Health Care industry

2008 – January 2010 (2 years)
Sr. VP, Area Manager
Kaiser Permanente

Nonprofit; 10,001+ employees; Hospital & Health Care industry

May 1997 – January 2008 (10 years 9 months)
Senior Administrator
University of Maryland, Baltimore

Educational Institution; 5001-10,000 employees; Higher Education

January 1994 – February 1997 (3 years 2 months)
Director of Finance

Educational Institution; 10,001+ employees; Research industry

1984 – 1994 (10 years)