Kaiser Refused Residential Treatment, Anorexic Man Says
By Ramona Young-Grindle
5-10-2017 00:00:00
SAN FRANCISCO (CN) – Despite multiple emergency hospitalizations for severe anorexia, a northern California man was denied a referral for follow up residential treatment under his Kaiser health plan even though his doctors and therapists agreed that was the appropriate level of care for him, according to a federal class action lawsuit filed in San Francisco.
I.M. sued Kaiser Foundation Health Plan Inc. on May 1 in U.S. District Court for breaching the Employee Retirement Income Security Act through its policy of not allowing plan physicians to authorize residential treatment for patients with eating disorders anorexia nervosa and bulimia nervosa.
ERISA regulates employee health plans, and the suit maintains that by violating federal and state mental health care parity laws, Kaiser’s policy does not conform to ERISA requirements.
"We do not believe Kaiser is in compliance with the California Mental Health Parity Act, which requires health plans to pay for all medically necessary treatment for people with severe mental illness," Kathryn Trepinski, one of I.M.’s lawyers, said.
"Generally speaking, Kaiser seems to provide some emergency room/acute psychiatric care, and limited outpatient therapy mostly on a group basis. The services in the middle, residential treatment, partial hospitalization, and intensive outpatient services, appear to be lacking."
The complaint notes that eating disorders, compared with other mental illnesses, have the highest mortality rate at 20 percent or more.
In addition to serious physical complications such as heart or kidney failure and cognitive impairment, the complaint says "suicide, depression and severe anxiety are common side effects throughout the illness and treatment.”
I.M., 29, was at times consuming as few as 50-100 calories per day and steadily losing weight during his two-year attempt to obtain appropriate care for his eating disorder from Kaiser, the suit states. Though the complaint identifies the plaintiff by his full name, an abbreviation has been used here because of privacy concerns.
Ryan Sallans, a spokesman for the National Eating Disorders Association, offered insight to the case. "Eating disorders are severe mental illnesses that are difficult to treat because of the complexities of the disorders," he said.
I.M. notes in the complaint that the therapist he saw in graduate school specialized in eating disorders. This non-Kaiser therapist allegedly said I.M. needed inpatient treatment as his condition was so severe that she could no longer treat him.
I.M. then saw his Kaiser primary care physician, and was referred to other Kaiser specialists including therapists, a dietician, a nurse practitioner and finally a psychiatrist, who recommended hospitalization.
Five weeks later, he was hospitalized in such severe condition that a feeding tube was required, the complaint states.
I.M. says he was then sent to another hospital, but on release, only outpatient support was offered, not the residential treatment his caregivers recommended. One of the outpatient programs was a support group, in which I.M. was the only one with anorexia, according to the complaint.
He says the two other programs sent him home because he was “unable to finish meals within the allotted time,” with one asserting that he “didn’t want to get better.”
“Many carriers require personal motivation or assuming personal responsibility for behavioral change as a condition to receiving treatment," Trepinski said. "This is not true for medical-surgical patients. We believe that this violates mental health parity laws, and is a form of discrimination against those with severe mental illness."
I.M. seeks class certification; payment of benefits; an order requiring Kaiser to pay for appropriate treatment for anorexia nervosa and bulimia nervosa; a declaration that Kaiser’s policy violates ERISA and other federal and state laws; and penalties and disgorgement of profits.
In addition to Trepinski, of Beverly Hills, he is represented by Lisa Kantor and David Oswalt in Northridge.
Kaiser spokeswoman Sara Vinson declined to comment on the case, citing a policy pertaining to pending litigation.
NEDA provided contact information: www.MyNEDA.org; Live Helpline: 800-931-2237; Text NEDA to 741741 for 24/7 crisis help.
Edited to conform to complaint redactions 2019.
