Kaiser Will Improve Treatment of Disabled

In an action that could dramatically change the way hospitals and clinics deal with the physically disabled, California health care giant Kaiser Permanente agreed Thursday to settle a lawsuit by launching a comprehensive review to correct its treatment of the disabled at scores of facilities statewide.

Because Kaiser is one of the nation’s largest health care providers, disability rights advocates called the proposed reforms historic and predicted that they would establish a blueprint for medical centers nationwide. They also praised Kaiser for its swift response to the reports of shortcomings at its facilities.

Problems at Kaiser ranged from a wheelchair patient being told by her doctor to weigh herself on a truck scale to physicians failing to treat pressure sores because patients were not lifted from their chairs during exams.

At a news conference in the Oakland offices of advocacy lawyers, Kaiser’s California Division president, Richard Pettingill, outlined a 12-point program designed to remedy a range of physical and emotional obstacles that activists say modern medicine has erected in the path of disabled patients.

Kaiser officials declined to estimate what the corrections might cost. But their plans include hiring independent consultants to oversee access and health care surveys, removing architectural barriers--everywhere from parking lots to examination rooms--and installing critical diagnostic equipment such as accessible scales and exam tables.

Also included will be sensitivity training for doctors, nurses and other staff in dealing not only with the physically disabled but with patients who have vision, hearing, cognitive and speech impairments. The reforms also feature a complaint system and ongoing advice from the disabled community, Pettingill said.

The company has designated two model facilities in San Francisco and Riverside that will serve as what it called “living laboratories” for corrections that will eventually take place at Kaiser’s 28 medical centers and more than 100 clinics statewide over the next two to five years.

Pettingill said Kaiser--California’s largest health care provider--is willing to share the results of its evaluation with its competitors and predicted “a ripple effect” within the industry by raising the standard of care for the disabled.

“As the bar goes higher for Kaiser,” he said, “it also goes higher for the health care industry in California and the nation.”

Kaiser’s actions settle a lawsuit filed by disabled advocates on behalf of three wheelchair patients who said they faced pervasive barriers at various Kaiser facilities--from labs and examination rooms that are too small for wheelchair users to heavy doors that lack automatic openers.

Advocacy lawyers said Kaiser doctors often performed cursory exams on patients in wheelchairs. One patient was told to weigh herself on a set of truck scales because clinic operators did not have a special device, which costs about $200.

“Patients with mobility impairments are either manhandled and treated as a burden, or they are left to fend for themselves,” the lawsuit claimed.

When giving urine samples, embarrassed wheelchair patients were often required to travel down a hallway to an accessible restroom and then carry the sample on their laps to return it to nurses. Nondisabled patients could leave their samples at a drop-off window inside the restroom that was too high for the disabled to reach, according to the suit.

Of Kaiser’s 8 million patients nationwide--6 million of whom are in California--more than 100,000 are disabled and about 40,000 use wheelchairs, according to advocates. Kaiser said it could not confirm those numbers.

Sid Wolinsky, director of litigation for Disability Rights Advocates, the Oakland-based nonprofit law center that sued Kaiser in July, praised the provider for its swift response.

Within a week of the suit’s filing on the 10th anniversary of the landmark Americans With Disabilities Act, Kaiser met with advocacy lawyers to hammer out the details of Tuesday’s agreement.

Kaiser began construction changes at its Riverside and San Francisco facilities before the settlement was reached. The provider has hired a company to design an adjustable exam table because it was dissatisfied with those available on the market. It will also attempt to expand the time clinic doctors spend with disabled patients to consider their special needs, Wolinsky said.

“Never in 40 years of litigation have I seen a company of this size react so swiftly and constructively to problems once they were pointed out,” he said. “We had dialogue instead of depositions. The result is a historical, unprecedented development in health care for people with disabilities.”

Health care experts agreed Tuesday that Kaiser’s reforms would be closely watched by the rest of the health care industry.

“Any time a giant like Kaiser initiates something like this, it’s going to be noticed by its competitors,” said Rick Wade, a senior vice president of the American Hospital Assn., which is based in Chicago. “A lot of places are going to take a close look at their internal processes and say, ‘We did some things 10 years ago with the Americans With Disabilities Act, but let’s look again.’ ”

Added Jan Emerson, a spokeswoman for the Sacramento-based California Health Care Assn.: “This is a significant development and could set a new nationwide standard in disabled care. Kaiser is a major player, and it seems to be taking this quite seriously. And I’m sure other organizations will soon follow.”

Advocates say the changes are long overdue.

Disabled patients nationwide are three times less likely to receive needed health care than able-bodied people. They are also four times as likely to have special needs not covered by health insurance, according to last year’s suit.

A 1999 medical journal study of 15,000 women nationwide also found that 44% of able-bodied women received mammograms, but only 13% of disabled women underwent the procedure.

There are more than 56 million Americans with disabilities, according to the 2000 census.

“Paternalism, exclusion and thoughtlessness on the part of the rest of society when dealing with the disabled is not absent in health care--in fact it’s more prevalent,” said Linda Kilb, an attorney with Disability Rights Education and Defense Fund, a Berkeley-based advocacy group that was not involved in the lawsuit.

“In most health care settings, people with disabilities are thought of as medical problems rather than as patients with rights.”

John Lonberg knows the pain of being invisible to his doctors.

The 63-year-old Riverside man, who suffered a spinal cord injury in 1983 and has no feeling below the chest, tried for years to convince his Kaiser clinic to install an accessible exam table and scale.

Instead, doctors estimated his weight gain or loss on each visit by gauging the tightness of his belt. Lonberg, a plaintiff in the lawsuit, said he was not weighed in more than 15 years and therefore was forced to play a guessing game with a major index of his medical status.

Lonberg said Thursday that he was impressed with Kaiser’s swift response. Within days of the lawsuit’s filing, he said, he received an invitation from the Riverside facility’s medical director to meet and discuss ways they could improve care there.

“I called the lawyers here to ask if I should even go meet with them,” he said at the news conference. “I wondered, ‘What kind of trick are they trying to pull?’ ”

Lonberg says officials have since made changes that included moving handicapped parking spaces closer to the facility and providing a weight scale and at least one adjustable exam table.

“It made me feel like a patient for the first time,” said Lonberg, who is 6-foot-8 and weighs more than 200 pounds. Then he quipped: “But I have to tell you, it was depressing to look at the numbers on that scale. I hadn’t realized that the batteries in my wheelchair had put on that much weight.”

Michael Neri, medical director of Kaiser’s Riverside medical center, said the extent of the difficulties faced by the disabled at his facility became clear when he accompanied a wheelchair patient on a visit.

“I learned some startling things--from doors that didn’t open easily to the quality of the care,” he said. “Change doesn’t come easily for anything like this, but we plan to do it in record time. Because it’s the right thing to do.”

Activists warned the nation’s medical community that more lawsuits could follow if conditions for the disabled do not improve.

Said Wolinsky: “This should be considered a wake-up call for the entire health care industry.”