Metzler et al. v. Kaiser Foundation Health Plan, Inc. et al.

V. IMPROVED POLICIES, PROCEDURES, AND PROGRAMS AFFECTING ACCESS

22. The parties will work together to make a good faith effort to identify a mutually agreeable expert or experts, referred to herein as "Access Policy Consultant(s)," who will be retained by Kaiser to provide consultation regarding policies, procedures, and programs that can improve access to quality health care for people with disabilities. Any and all expert(s) shall meet with the approval of both Kaiser and Plaintiffs, provided such approval is not unreasonably withheld. In the event that the parties are unable to identify a consultant with the appropriate expertise in a particular access-related area or areas, or in the event of the parties’ mutual agreement, the parties will instead jointly select individuals who will comprise an "Access Policy Work Group" that will serve the same functions as would an Access Policy Consultant. The Access Policy Consultant(s) and/or Access Policy Work Group shall be put in place within ninety (90) days of the effective date of this Agreement. If the parties so agree, reliance on the outside consultant(s) (i.e., the Access Policy Consultant(s)) and the Work Group need not be mutually exclusive and the parties may adopt an approach that employs both the Work Group and third-party consultant(s) if and when it is appropriate to do so.

a. Members of the Access Policy Work Group may include Kaiser employees and members and other individuals with appropriate background, experience, and knowledge regarding health access issues for people with disabilities. The Access Policy Work Group members shall include, to the maximum extent possible, people with disabilities. Before making any decision regarding a policy, procedure, or program with a direct effect on a subclass of people with disabilities (such as persons with hearing disabilities, persons with vision disabilities, persons with developmental disabilities, or those with mobility disabilities) the Access Policy Work Group will first consult with individuals who are members or representatives of that subclass.

b. The members of the Access Policy Work Group shall designate a chair who will be responsible for overseeing and coordinating the work of the Access Policy Work Group and for reporting to the third-party Facilitator and Plaintiffs’ Counsel.

c. During the first two years following the effective date of this Agreement, the Access Policy Work Group shall submit, to the third-party Facilitator and Plaintiffs’ Counsel, written reports every ninety (90) days, documenting the Group’s examination of policies, procedures, and programs affecting the access of people with disabilities to Kaiser health services and recommending improvements for those policies, procedures, and programs. Thereafter, these reports shall be submitted to the third-party Facilitator and Plaintiffs’ Counsel every six months.

d. The Access Policy Work Group shall work in cooperation with the Program Manager and/or Access Coordinator (or Coordinating Committee), Kaiser’s Clinical Protocol Work Group and Kaiser’s Education & Training Work Group and any relevant third-party consultants retained by Kaiser.

e. The Access Policy Work Group shall report directly to Kaiser’s ADA Advisory Committee.

f. Kaiser shall ensure that the Access Policy Work Group has sufficient resources to fulfill its mandate. Kaiser shall bear the costs and expenses of the Work Group.

23. With the assistance of the parties, the Access Policy Consultant(s) and/or the Access Policy Work Group will review any and all Kaiser policies and procedures (or the absence thereof) that may tend to discriminate against people with disabilities, lead to their segregation, and/or impede their full and equal access to comprehensive health services and, where appropriate, will recommend reasonable modifications that Kaiser will adopt and implement to improve access for people with disabilities. With respect to the model facilities, this review, recommendation, and implementation process shall be completed within one year from the effective date of this Agreement. The review, recommendation, and implementation process for all Kaiser facilities in California shall be completed within three years from the effective date of this Agreement.

24. Plaintiffs have raised issues concerning Kaiser's policies and procedures for the procurement and maintenance and repair of durable medical equipment for members with disabilities. The parties have determined that they need additional time to address these issues. Accordingly, the parties agree to use their best efforts and to proceed in good faith to address these issues and arrive at a future agreement resolving them. In the event that such an agreement is not reached, the release provided in Paragraphs 41 -42 shall not apply to plaintiff's claims relating to durable medical equipment.

25. With the assistance of the parties, the Access Policy Consultant(s) and/or the Access Policy Work Group will review Kaiser’s policies and procedures (or the absence thereof) for addressing the communication needs of people with vision, speech, hearing, and cognitive disabilities and, where appropriate, will recommend reasonable modifications that Kaiser will adopt and implement. With respect to the model facilities, this review, recommendation, and implementation process shall be completed within one year from the effective date of this Agreement. The review, recommendation, and implementation process for all Kaiser facilities in California shall be completed within three years from the effective date of this Agreement.

26. Kaiser will in good faith assess its existing system to inform patients when they are due for certain health services, particularly those aimed at prevention and early detection of illnesses and other health problems. With the assistance of the Access Policy Consultant(s) and/or the Access Policy Work Group and in consultation with Plaintiffs’ Counsel, Kaiser will in good faith then assess whether such as system should be modified to ensure more effective communication of this information to members with disabilities. This assessment and the implementation of any appropriate modifications will be completed as soon as reasonably possible and in no event later than three years from the effective date of this Agreement.

27. With the assistance of the Permanente Medical Groups in Northern and Southern California and, to the extent determined appropriate by the parties, jointly-selected consultants with appropriate expertise, and with input from Plaintiffs’ Counsel, Kaiser will develop a training program to educate its health care professionals about treating people with disabilities. The goals of this training will include helping providers become more sensitive to the needs of people with disabilities and informing providers about disability-specific issues that arise in delivering health services to this community. This training will comprehensively address the range of issues that relate to the delivery of health services for people with disabilities; training curriculum topics may include:

(i) dealing with disability in the health care profession, (ii) the culture of people with disabilities, (iii) treating disabilities in connection with broader health concerns, (iv) the relationship between disabilities and standards of care and treatment protocols,

(v) problems with the medical model of disability, (vi) access needs and legal responsibilities, (vii) health care concerns of women with disabilities, including reproductive health care, pregnancy, rape, and abuse, and (viii) advancements in adaptive technology for people with disabilities. This training program will be developed and implemented within two years of the effective date of this Agreement.

a. If it is not possible to make the training mandatory, Kaiser will strongly advise its health care providers to participate in the training. To encourage this participation, Kaiser will make its best effort to enable its doctors to earn Continuing Medical Education credits for participating in the training.

28. In conjunction with the development of the training curriculum for health care providers, Kaiser will develop a handbook dealing with the delivery of accessible health services for people with disabilities. Kaiser will provide this handbook to all its health care providers. This handbook will be developed and distributed within three years of the effective date of this Agreement. In addition, plaintiffs will develop a handbook dealing with the delivery of accessible health services for people with disabilities and their families (Disability consumer Guidebook). Kaiser agrees to make reasonable and good faith efforts to assist in distributing the Disability Consumer Guidebook to its members with disabilities. Kaiser is not obligated to pay any costs for this purpose.

29. At the appropriate times, Kaiser’s California Division President and Medical Directors will circulate memoranda to all Kaiser employees, reiterating Kaiser’s commitment to providing equal access for people with disabilities and explaining any new policies and procedures and access features that will effectuate that goal.

30. The Permanente Medical Groups will in good faith consider whether it is appropriate to implement specialized clinical programs in disability care. The exploration of the propriety of developing such a specialization will include consideration of the standards of care for people with disabilities and how care can be better delivered and managed to achieve improved health for people with disabilities. In the event that Kaiser, with input from the disability community, decides it is appropriate to develop disability clinics (akin to clinics for women’s health care or geriatric care) at certain Kaiser medical centers, such clinics shall supplement, not substitute for, the provision of comprehensive, accessible health services in a fully integrated setting. The decision whether to develop some form(s) of specialization in care for people with disabilities shall be vested with the Permanente Medical Groups, as this determination involves questions regarding the practice of medicine.

31. If and when the parties make a good-faith determination that it is appropriate (for example, as improved access features and policies are integrated into Kaiser’s facilities and health care programs), Kaiser will conduct outreach to members with disabilities to inform them of improved access features, policies, and programs and other pertinent information that may help improve access to regular and comprehensive health care. In addition, Kaiser may of its own accord determine that such outreach is appropriate. This outreach may include the distribution of written materials (with alternative formats) regarding the health-care-access needs and rights of people with disabilities. Plaintiffs’ Counsel shall cooperate with Kaiser to ensure the efficacy of outreach efforts and shall participate in the development of outreach and education materials.

32. The parties, with the assistance of the specialists and consultants provided for herein, will identify steps that Kaiser shall take to improve access pending full implementation of the access plan. These interim steps may include, for example, providing care at nearby Kaiser medical facilities that have accessible medical equipment when a member’s local Kaiser facility does not have such equipment. In the event no Kaiser facility has accessible medical equipment medically necessary for the member’s care, Kaiser will pay for care provided at a non-Kaiser facility when a patient is referred by a Permanente Medical Group physician.