Kaiser sued for discimination against autistic children:"Sham excuses"

News Release:

OAKLAND, Calif. — A class action suit filed today in state court in Alameda County charges that health care organization Kaiser Permanente directs a “blatantly discriminatory” policy against children with autism.

The class action suit, seeking relief on behalf of children with autism and their families who are members of Kaiser, was filed by Disability Rights Advocates (DRA), a Berkeley-based non-profit law center, and Chavez & Gertler, a national class action litigation law firm. Other major counsel are Gerard V. Mantese and John J. Conway. The suit seeks to end discrimination against disabled children and does not request money damages.

Parents of disabled children charge that Kaiser, the largest integrated health care delivery system in the country, has as a matter of policy systematically refused to provide treatment for children with autism. Kaiser’s status as a health care service plan provider, federal and state anti-discrimination law, statutory requirements, and Kaiser’s contract with its enrollees all prohibit Kaiser from implementing blanket refusals to treat children with autism. According to the suit, Kaiser is required to treat autism as fully as it would a heart condition or diabetes, but Kaiser refuses to do so

Background

Autism is a neurobiological disorder that is estimated to occur in one out of every one hundred and fifty births nationwide, and most often appears by age two. People with autism spectrum disorders (ASD) display severely impaired language and communication skills, impaired social interaction, restricted interests, repetitive behavior, resistance to change, obsessive attachment to objects, decreased motor skills, and lack of emotional connection or comprehension. Without proper medical care and treatment, ASD can be a debilitating condition, leading people to grow into adulthood without the ability to perform the most basic functions. With early and proper treatment, however, children with autism can see significant gains in their ability to interact and function in society. Early and effective treatment can also save hundreds of thousands of dollars in future medical costs.

Kaiser’s “sham excuses”

Kaiser cites a variety of reasons for denying treatment to children with autism. These include the excuse that treatment for autism is not a “health care service” and labeling treatment as “educational”. The lawsuit states that each of these reasons is explicitly invalid according to health and anti-discrimination laws, as well as Kaiser’s own Evidence of Coverage. For example, Kaiser systematically denies occupational, physical, and speech therapy to children with autism, despite prevailing opinion in the medical community that these are basic and necessary health services for patients with ASD. Furthermore, Kaiser provides occupational, physical, and speech therapy treatment for other disorders, but not for autism

Negative Effects

The lawsuit alleges several ways in which Kaiser’s policy negatively affects the child, the child’s family, and the public. The complaint refers to a body of research showing that there is a critical window of opportunity for treatment in the development of a child with autism, and that serious damage can occur if the family is denied coverage by its health care provider during this critical window.

Secondly, the medical treatments that Kaiser denies to a child with autism can place significant financial stress on families, who must already bear the strain of caring for a child with autism. It forces parents to weigh the emotional and mental burden of watching their child deteriorate against the financial cost of securing necessary treatment. Many families do not even have the financial means to make this tragic trade off.

Thirdly, denial of treatment puts an unfair strain on the public. Although Kaiser provides speech therapy and occupational therapy to its members for other physical and mental conditions, it insists that children with autism seek those services from publicly-funded school districts and regional centers for people with developmental disabilities, thus directly making taxpayers pay for treatment for which Kaiser is responsible and for which Kaiser collects premiums.

Anna Levine, an attorney for Disability Rights Advocates, commented: “Kaiser claims to help people holistically “thrive,” but denies children with autism basic care. Kaiser’s flagrant neglect of its duties as a health care provider has caused fully-insured families emotional pain, financial hardship, and irreversible damage to their children’s health and development. It’s time we hold Kaiser accountable.”

Mark A. Chavez, co-counsel on the case, commented: “Kaiser’s policy to deny treatment for autism is shameful and unlawful. Kaiser should not be allowed to continue treating children with disabilities unfairly. These children are the most fragile victims of an uncaring corporation, and we can no longer allow Kaiser to let them slip through the cracks.”