April 13, 2001
By TAMAR LEWIN
The nation's largest nonprofit H.M.O. agreed yesterday to revamp all its California health centers and policies to ensure that people with disabilities have access to the full range of health care.
The agreement will settle a class- action lawsuit, the first of its kind in the nation, that was filed last year against the health maintenance organization, Kaiser Permanente, on behalf of all its California members with disabilities. The lawsuit argued that Kaiser discriminated against disabled patients by giving them inferior medical care.
Part of the problem, the lawsuit said, is inaccessible medical equipment, like examination tables that do not lower and scales and mammography machines that cannot be used by people in wheelchairs.
The three named plaintiffs are all Kaiser members who use wheelchairs. One of them, John Metzler, had pressure sores on his buttocks for a year, but his doctor had not visually examined them because the examination table was inaccessible. Another, Johnnie Lacy, had not had a gynecological examination in more than 15 years because of the same problem. The third, John Lonberg, was not weighed for 15 years because there was no scale accessible to a wheelchair at his Kaiser doctors' office.
"My first reaction was, `Oh, my God, we have a lawsuit,' " said Richard Pettingill, president of Kaiser's California division, "but it only took about five minutes before it was apparent to me that we needed to step up and provide some leadership."
The settlement Kaiser agreed to is far-reaching, covering not only the installation of accessible medical equipment and the removal of architectural barriers, but also a broad commitment to develop training programs, handbooks and a complaint system to meet the needs of the disabled. Kaiser also agreed to consider developing specialized clinical programs in disability care and to review all its policies to ensure that they meet the needs of people with vision, hearing, cognitive, speech and mobility disabilities.
"We believe this will be revolutionary in terms of its impact on health care for people with disabilities," said Sid Wolinsky, litigation director of Disability Rights Advocates, the Oakland group that brought the lawsuit. "The agreement with Kaiser provides a comprehensive blueprint that could be used by any health provider anywhere in the country. We intend to use this as a template to present to other major health-care providers, to urge that they, too, adopt this approach."
While the settlement covers only Kaiser's California operation, Mr. Pettingill said that whatever Kaiser found to work well in improving health care for the disabled in California would be shared with its operations nationwide and other health care providers. Kaiser has six million members, 28 hospitals and 7,000 doctors in California, and a smaller number in nine other states.
"This is a learning experience," said Dr. Michael Meri, medical director of Kaiser's Riverside hospital. "We're talking to the manufacturers of equipment.
"I'd like to see X-rays and all the diagnostic machines more accessible for people with disabilities. I'd like electronically operated scales where patients get on in their wheelchair, and get a printout we can put in the chart. Right now, it's all a big surprise: `Mr. X is here and he's in a wheelchair.' We need to be aware of those needs, and ready, before they arrive."
Neither Kaiser nor the advocates for the disabled had an estimate of how much the new programs would cost.
"The money issue never came up," said Terry Lightfoot, a Kaiser spokesman.
Mr. Wolinsky said that while some pieces of the settlement, like training, could be accomplished without additional expenditures, others, like removing architectural barriers, would be expensive. An examination table that lowers, he said, is about $1,000 more than the regular cost of $3,000.
The legal complaint against Kaiser ticked off a litany of problems: too-small examination rooms, doors too heavy to be opened from a wheelchair, too-high counters, inaccessible restrooms, lack of nearby parking.
Such inconveniences can contribute to serious problems.
Mr. Lonberg, a 53-year old Riverside man who was paralyzed from the chest down in 1983, said he was struck by how much his health care had changed since his injury.
"It took a while," he said, "but I gradually realized that I wasn't getting the same level of care I had received when I could walk, and get on the scale, and climb up on the examination table. Doctors were prescribing dosages based on what they guessed I weighed, so I began thinking maybe I should be weighed. And doctors stopped routinely examining the back of my body, because it's so difficult to get clothes on and off when you can't stand up that they took the easy way out."
Without such examinations, Mr. Lonberg finally developed a pressure sore, which, because his paralysis prevented him from feeling it, was not discovered until it had become a serious problem, requiring major surgery and months in bed.
Several studies have shown that people with disabilities are less likely than others to have Pap smears, mammograms, gynecological exams, immunizations or counseling about tobacco, drugs or alcohol.
For the most part, the medical world has not addressed the issue.
"I don't know of anything but a few isolated clinics and a few isolated practitioners who identified it as a problem," Mr. Wolinsky said. "I think it was a new issue for Kaiser, and when they began to look into it, the medical directors quite readily agreed that these were issues they need to address."
Kaiser put some elements of the settlement in place even before the agreement was final: it hired specialists in architectural access and appointed an access coordinator. It has chosen its hospitals in Riverside and San Francisco as models where the new policies will be worked out.