[Updated September 12, 2019 to add link to our archive of Arce vs. Kaiser autism class action lawsuit documents and court filings]
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.
Meanwhile, Kaiser’s 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.
Unfortunately, $75,000 is chump change for Kaiser. KP is probably laughing all the way to the bank while a child was denied treatment. Shamefull, but not surprising.
Agreed. I even used the exact term “chump change” when I was discussing this earlier today. However, every little bit helps with regard to the charges whether the dollar amount matters or not.
Delay, delay, delay… that seems to be all kaiser knows how to do…in addition to continuously deceiving the public.
Still baffled how a “health care organization” can do business by actually preventing, delaying and denying health care.
This is NOT health care.
Kaiser should just go away and make room for an ethical group that actually will do what they are supposed to do, which is to PROVIDE CARE.
I’m looking forward to the day when they are hit with the big one, instead of chump change. Then we will see who is laughing. I’m hoping their pocket book is hit so deep they won’t be able to afford any more false advertising.
It is said that those doctors who swore in and said they would put patients live on top and then greed (provider profits) got their best and mask their eyes. Those doctors should not be practice anymore period. Let’s clean the health care system fast before it is completely collapse right in front of our eyes. Bier said ” American health care was devil ” I am soo agree with his statement.
I was told repeatedly by kaiser that a hospice patient through them, was not elligable for adaptive eating equipment, nor was she eligable to receive PT visits to maintain her strength for quality of life. This is not isolated. We are also constantly forced to fight with them to keep them from dumping patients that are over the age of 65 and on medicare to fast. one day after five heart stent placements? come on! Still bleeding from the rectum with a H&H at 9 with IVF?sent back to us, no discharge paperwork and half an hour notice, charging the family for transport. They make me sick. i spend all day fighting with them to get my residents care. We recently had a death from a man whose kaiser physician would not give PT or see him for the steady and quick decline in strength, only to see him one day…we finally got his doctor switched the next, she found out he needed two pints of blood and then he died two days later. Kaiser has a special place in hell
The same situation happened with my daughter whose developmental delays which were clearly documented in her well baby checklists were ignored and the Kaiser pediatrician dismissed our concerns about autism. The second time we brought it up, he said, don’t worry all kids have a little autism in them.” We finally had to demand a referral to our developmental pediatrician. By this time, our daughter was three-and-a-half years old — too late for early intervention! We’ve had to rely on the school system for everything.