This is an interesting find. Seems that Kaiser Permanente was fined an administrative penalty of $75,000 by the California Department of Managed Health Care (DMHC) back in June 2010, for unnecessarily delaying Andrew Arce’s autism treatment. The Letter of Agreement doesn’t have the patient’s name on it, but a little birdy inside Kaiser assures us that Andrew is indeed the member in question, and all of the facts fit. It’s a long letter that interested parties can read here, but we have pulled out the highlights from the DMHC’s conclusions below:
- Concerns initially raised by Andrew’s father about his son’s developmental delays, which should have raised red flags with the Kaiser pediatrician, were basically ignored, therefore closing the window when experts agree that autism screening and evaluation can result in an early diagnosis and critical early intervention.
- After several more months passed and Andrew’s father raised concerns about his son’s issues for the second time, the pediatrician referred Andrew for evaluation by speech and occupational therapists instead of a formal autism evaluation.
- When the speech and occupational therapists both noted significant developmental delays and referred Andrew to the team of specialists that conducts formal autism assessments, a series of bumbling administrative and communication errors led to another 4 month delay before he was able to get an appointment for the evaluation.
- In February of 2008, when Andrew was finally evaluated by the team of autism specialists, Andrew’s father was forced to file a grievance with Kaiser because the treatment plan was deficient. Kaiser then denied that grievance on medical necessity grounds.
- 13 long months after Andrew’s father first expressed concerns about his son’s developmental delays, an Independent Medical Review (IMR) overturned Kaiser’s denial, allowing Andrew to get the treatment he needed — AFTER THE DAMAGE FROM DELAYS BY KAISER WAS DONE.
- The DMHC found that the conduct of Kaiser Foundation Health Plan and the Southern California Permanente Medical Group resulted in an unreasonable delay of the formal autism evaluation, as well as the IMR process. It was concluded that Kaiser was out of compliance with several provisions of the Health and Safety Code and the California Code of Regulations, and that there was sufficient evidence to proceed with an official Accusation asserting that violations of the Knox-Keene Act had occurred. A penalty of $75,000 was assessed.
Ministry of Truth PR goons continue to characterize KP as “leaders” in the field of autism treatment, despite all evidence to the contrary. Ever wonder how they can do that and keep a straight face?
See our prior posts for more information on the Arce v. Kaiser Autism Class Action Lawsuit.