Kaiser Refused Residential Treatment, Anorexic Man Says
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.

Ian Moura sued Kaiser Foundation Health Plan Inc. on May 1 in U.S. District Court for breaching the Employee Retirement Income Security Act (ERISA) 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 other federal and state laws regarding health plan discrimination, mental health care parity, and determination of appropriate care by care providers not corporations, 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. 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,” Kathryn Trepinski, one of Moura’s lawyers, said.

“Eating disorders have the highest mortality rate of any mental illness, in excess of twenty percent,” according to the suit. In addition to serious physical complications such as heart or kidney failure and cognitive impairment, “suicide, depression and severe anxiety are common side effects throughout the illness and treatment.” 

Moura, 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. Moura is a transgender man who began struggling with his weight before puberty in an effort to maintain an androgynous appearance, as he found “the idea of female secondary sex characteristics profoundly distressing.” He has legally changed his name and gender. “We believe Mr. Moura’s transgender issues complicated his case,” Trepinski said.

“Eating disorders are severe mental illnesses that are difficult to treat because of the complexities of the disorders. In this particular case, the client’s transgender identity presents an extra barrier to treatment due to many treatment facilities not being equipped and appropriately trained in working with patients who are transgender,” Ryan Sallans, spokesperson for the National Eating Disorders Association, said about the lawsuit.

While he was in graduate school, Moura’s non-Kaiser therapist, an eating disorder specialist, said that he needed inpatient treatment as his condition was so severe that she could no longer treat him, the suit claims. Moura 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, Moura’s suit states.

Moura was then sent to another hospital, but on release, only outpatient support was offered, not the residential treatment his care givers recommended, he said. One of the outpatient programs was a support group, in which he was the only one with anorexia, and 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,” he said. 

“Many carriers require personal motivation or assuming personal responsibility for behavioral change as a condition to receiving treatment. 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,” Trepinski said.

Moura 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.

He is represented by Lisa Kantor and David Oswalt in Northridge, and Kathryn Trepinski in Beverly Hills.

When asked for a response, Kaiser spokesperson Sara Vinson said, “We are not able to discuss pending litigation.”

NEDA provided contact information: www.MyNEDA.org; Live Helpline: 800-931-2237; Text NEDA to 741741 for 24/7 crisis help