In April we posted a request from California attorney Scott Glovsky, who is seeking plaintiffs for a class action lawsuit against Kaiser Permanente for refusing to cover treatments for autism as required by law. The lawsuit — which was filed on behalf of Andrew Arce, a two-year-old child Kaiser has denied treatment — alleges breach of contract, bad faith, and unfair dealing, and is seeking class action status on the third complaint. (Read the recently amended lawsuit here).
In the Sunday, July 6th Los Angeles Times, Lisa Girion tells Andrew’s story:
An explosion in the number of children diagnosed has parents, insurers and state and private institutions battling over coverage. The case of Andrew Arce is a window into the conflict.
By the time Andrew Arce was 15 months old, his parents suspected he was autistic.
He refused to cuddle, flapped his arms and stared into space a lot. On occasion, he picked at his nose until it drew blood and, with it, smeared the walls of the family’s Pasadena town house.
It was nearly a year, Guillermo Arce said, before Kaiser Permanente, the family’s healthcare provider, confirmed their fears. The diagnosis wasn’t much help, though. Kaiser refused to provide most of the treatment that specialists said Andrew needed — until the state ordered it to in April.
Always true to form, Kaiser’s PRBS response not only denies all responsibility, but the creeps actually have the nerve to characterize themselves as “leaders” in the field of autism treatment after being found in violation by regulators. This is beyond disgusting, and a completely heartless and unnecessary slap in the face to the families whose children have been victimized.
Just once we would like to see Kaiser decline to add insult to injury by accepting responsibility for wrongdoing and making amends, but of course we won’t be holding our breath.
Previously:
California attorney seeking plaintiffs for autism class action
More:
From the Los Angeles Daily Journal: Families of Autistic Children, Insurers Battle Over Coverage
Kaiser Thrive Exposed would like to personally thank Dr. Geoff Galbraith - Kaiser Permanente Care Management Institute board member; and Vice President, Hawaii Permanente Medical Group, Quality Improvement Management - for inspiring us to create this website. Did we make it into the top 5?
I commend this family for all that they have done legally while caring for their son. I find it ironic that an autistic child has given voice not only to his own plight and that of other children similarily afflicted but through his lawyer articulated suffering of every other victim of Kaiser: “…Kaiser…[has] breached their duties of good faith and fair dealing owed to plaintiffs [aggrieved members] by other acts or omissions of which plaintiffs are presently unaware and which will be shown according to proof at the time of trial.” I wish the Arce family and all others who join this suit and the law firm representing them the best as they fight the beast. A little justice for one or some members is a victory for all of us who have suffered medically and been abused legally by the system/organization.
I absolutely agree with anon above when he said “A little justice for one or some members is a victory for all of us who have suffered medically and been abused legally by the system/organization.”
I wish this Family my best and for the strength it takes fighting this barbaric bureaucracy called kaiser.
This fits in with the Kaiser pattern of treating patients like sheep they can herd, in this case to state-funded institutions. If a child is trapped in the DD system, he’s very unlikely to be able to get back out and be “seen” at Kaiser ever again.
Add Autistic children to the quickly growing list of patients that Kaiser wants to get rid of (elderly, chronically ill….etc).
New study out on autism!
Kaiser = 0, Autism Activists = 100!
>>Gene reactivation may now explain why early intensive therapies on children with autism can be so effective.<<
http://abcnews.go.com/WN/Autism/story?id=5351148&page=1
Is kind of ironic that Dr. Brookey says in the Daily Journal article that Kaiser provides treatment for autistic children, but then says that they are best treated in the community. WTF?
In summary, Kaiser does not treat children with autism. If it has the feathers of a duck, the beak of a duck, the web feet of a duck and goes quack quack like a duck, then it is a DUCK!!!
And that DUCK is Kaiser. Quack, Quack.
Bunch of Quacks they are.
Kaiser doesn’t treat, period. They just blow a lot of hot air to make themselves look good.
Here is Kaiser’s official response to the LA Times story. (Link at bottom.) It is absolutely stunning. I spent WAY too much time doing this, but I love this PR bull****. Here are some highlights of Kaiser’s response, and my translation or comments:
First paragraph:
Translation: “It’s an educational issue.” Note lack of support for this claim. “Work with”, OK, fine. “Completely abdicate responsibility to”, not OK.
Translation: “PLEASE don’t certify the class action.”
Translation: “We diagnose, then ‘coordinate’ the care provided by others. This means we tell parents to go to the schools or Regional Centers. Heck, we’ll even have our case managers attend their IPP’s or IEP’s with them to try to get those other entities to provide service, so the parents won’t pester us for that costly treatment.”
Translation: “We haven’t had to do it before now – other folks have done that for us. Can’t we keep it that way?”
Translation: “It’s, uhm, not a medical need [cough], it’s an educational need. Really. Honest.”
Translation: “PLEASE don’t certify the class action. Pretty please?”
Translation: “Did we mention that we haven’t had to provide treatment before now, since everyone else has done that for us? We’d like to keep it that way please. It’s really expensive. It would really eat into our revenue if someone made us treat this medical [ACHOO] — ahem, strike that – educational condition.”
This is an ABSOLUTELY FASCINATING comment! Purchasers? They can mean only one of two possible things here. The first is what they actually wrote: “Purchasers” – in which case they are admitting that people paying their premiums (“purchasers of private health insureance”) aren’t getting treatment and are bearing the cost themselves. The second is precisely the OPPOSITE of what they wrote – “Providers” (i.e., Kaiser) – in which case they mean that it’s way too expensive for them to bear the cost that they contracted (and took insurance premiums) to bear, and that their obligation should therefore be shouldered by families, schools and the public. Incidental is the implied confession, by substitution of “provider” with “purchaser”, that they can’t even bring themselves to say this straight out! Simply FASCINATING!
STUNNING! This goes against ALL the research regarding plasticity of the brain, developing neural pathways, and overwhelming evidence that such therapies actually heal. Behavioral issues only affect educational objectives? Have these folks actually ever met an autistic child? What about after school? Weekends? Adult autism? Autism behaviors are not Clinical?!?!?! This comment is so insupportable it takes my breath away!
Translation: “Any old yahoo can do that for you! You don’t need us! Oh, and it needs to be done at home. That would be REALLY expensive, so it must not be our responsibility. We don’t make house calls, so its isn’t covered. Ipso Facto. That’s Latin. It means we’re right. So just agree, OK?”
Translation: “We’ve lost some, but we’ve won a few too. (Heck, ya gotta expect that, right? We’ve got more money and resources than you.) We like to focus on the ones we’ve won, and pretend that the ones we’ve lost don’t really count. Will you please cooperate and join us in our myopia?”
Translation: “We’re looking closely to see if chinks are showing up in our armor, and considering if we need to revise our strategies of denying care.”
Translation: “We found one report in which doctors happened to include it in an educational category. Lawyers would call that dicta (or, “not the point”), but heck, we’re not lawyers. (We use a lot of ‘em, but that’s a different story.) Anyway, we found it, so we’re seeing if it’s strong enough to hang our hat on. Also, it dovetails nicely with our theory that since we haven’t had to provide treatment before now, we must not be obligated to. Logicians would call that “begging the question.” Ordinary people would call it “bootstrapping.” But since we’re not logicians or ordinary people, we don’t see it that way. And we hope you simply won’t notice.”
Translation: “If we’re losing some ground here, we’re looking hard for the next fall back position, and ways of limiting coverage and minimizing costs to the extent possible.”
Translation: “Did we mention before that we only want to coordinate care provided by others? Yes, that’s what we’d like your feedback on – how we are doing in that area. We’d love your suggestions on how we can improve our ability to get others to provide the services. Please don’t give us any feedback on how we are doing actually PROVIDING services. WE don’t want to generate any print on that subject. If we say “coordinate” enough, you may come to believe that’s all we’re required to do.”
Translation: “Lest there be any doubt, rest assured that given the enormous cost, we will not change the way we do business unless we are absolutely forced to.”
Read the whole Kaiser response here:
http://xnet.kp.org/newscenter/stories/nat/2008-07-06.html
Anon, your post was hilarious, in the meantime, regardless of what Kaiser says, they are still denying treatment to children with autism.
Sadly enough, the Regional Centers are pretty lousy themselves at treating autistic kids. My son was diagnosed by Kaiser as autistic, but the Regional Center refused to recognize or accept the diagnosis. Kaiser told us to go to the Regional Center for treatment.
It’s all crap. Medica hot potatoe.
Well, this is where Kaiser wants you to seek treatment. However, how is the Regional Center, if they won’t even accept Kaiser’s diagnosis. Like you said, crap all around!
[...] Kaiser Permanente is attempting to compel arbitration in the Arce vs. Kaiser autism lawsuit. Why? Because arbitration is a closed proceeding that is rigged in KP’s favor, of course! [...]
“Kaiser Permanente Southern California has teams of autism experts” I worked for SCPMG for over 17 years, will someone please tell me where these “teams” are? I certainly never saw them!