Insurance companies question/deny autism chelation clinic's charges

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HEALTH CARE

Insurance companies question autism clinic's charges

Owner of clinic, which uses controversial therapies, says she's had to lay off

staff, cut hours.

By Ann Roser

AMERICAN-STATESMAN STAFF

Sunday, May 03, 2009

The owner of an Austin-area clinic that treats children with autism — using

techniques that are controversial in mainstream medicine — says investigations

by three major insurers have left it with a pile of unpaid claims and a crisis:

She's had to lay off most of her staff and drastically reduce the clinic's

hours.

In addition, Kazuko Grace Curtin said the Texas Medical Board is investigating

her medical director. She and the doctor — Jesus Caquias — say the investigation

is a way of harassing them because they offer nontraditional care for autism

patients.

Curtin, who has no formal medical training, said she founded the clinics because

her son, now 14, has autism and she was frustrated by doctors who said he could

not be helped. So, in 2003 she opened CARE Clinics, a 9,000-square-foot facility

at 4201 Bee Cave Road.

She said that she and her husband, Jim Curtin, " made over $100 million " when the

software company he headed, Dascom Inc., was sold to IBM but that she started

the clinic with $17,000 in her own bank account. In June, she opened a second

clinic in Tampa, Fla. The clinics mainly provide medical treatments to children

with autism.

Curtin says they've treated more than 5,000 patients from around the world,

performing more than 20,000 intravenous therapies, including chelation therapy.

Chelation, which introduces a chemical solution into the body to bind with a

metal or other substance to be removed, is controversial.

It's approved by the Food and Drug Administration only for removing lead from

the blood, and though doctors use it for other purposes, such as treating heart

disease and cancer, some practitioners say it can be dangerous, especially when

used for treatments other than lead removal.

The National Institute of Mental Health canceled a study on chelation in

autistic children last fall, saying the money would be better spent on other

therapies. Agency officials were quoted at the time also citing safety concerns.

Autism is a complex neurodevelopmental disorder marked by speech difficulties

and odd behaviors. Behavioral therapy is widely accepted treatment for autism,

but even insurance coverage for that scientifically proven therapy can be

spotty. Insurance companies often do not pay for medical treatments for autism.

Though some parents who have brought their children to CARE Clinics say they've

seen improvements, critics say it uses therapies that lack strong scientific

proof they work.

Dr. Alan Woolf, director of the pediatric environmental health center at

Children's Hospital in Boston, said he was not personally familiar with CARE

Clinics but was aware of doctors and clinics that offer to treat autism with

similar therapies.

" We ask parents to be cautious because (autism) is a condition without a known

etiology (cause) in most cases, " Woolf said. " In that environment, parents are

easily misled or will grasp onto a theory or a belief because they're desperate

and looking for answers. "

CARE Clinics is struggling now because Aetna stopped paying claims in August and

is questioning " about $1 million " in claims, Curtin said. Cigna and United

Healthcare stopped payments in October and are disputing smaller amounts that

Curtin declined to reveal. United is paying again but at a lower rate, she said.

" What they were saying is, autism treatment is not established, it's

experimental, " Curtin said.

Spokeswomen for Cigna and United said the reviews were routine to ensure proper

payments. Aetna declined to comment.

Curtin said she closed the two clinics in January to cope with the amount of

paperwork she had to produce when the three insurance companies challenged

charges for all patients treated in October, November and December. She reopened

the Austin clinic March 6, but now it's open 10 days a month instead of 20 and

has 10 employees instead of 40, she said. The Tampa clinic won't reopen until

May, she said.

She also is delaying indefinitely a 30,000-square-foot medical building, school,

corporate offices, sports facility, lodge and conference center in Dripping

Springs.

" I need some funds, " Curtin said, declining to release specific financial

details about her business. " I don't know how long we can survive. "

The clinic performs more than 20 tests on each child that cost " several hundred

dollars " each, said Caquias, who practices general medicine,.

The tests help them identify ailments that Curtin says are common in autistic

children: amino acid deficiencies, immune system dysfunction, gastrointestinal

problems, multiple infections, food allergies, neurotoxicity and other

impairments.

" Since this is a long-term solution that may need to be repeated over several

months to several years, it can be quite costly in the tens of thousands of

dollars, " Caquias wrote in an e-mail. " Some children respond very well after

just a few interventions, while others require many more interventions to

achieve the same response. "

" We have cured many kids, " Curtin said.

Conventional doctors who work with autistic children say there's no cure.

CARE Clinics bill insurance companies for a variety of treatments for ailments

such as metabolic syndrome, mitochondrial dysfunction, gastrointestinal problems

and other disorders based on the child's test results, Caquias said. The autism

is related to those underlying disorders, and when corrected, the autism

improves, he said.

" We really don't treat the autism per se. We treat all of the issues the patient

has, " Caquias said.

Mainstream doctors say while some patients seem to have higher-than-normal

gastrointestinal problems, doctors do not routinely see the medical problems the

CARE Clinics treats in autistic children.

" There is a lack of support for those claims, " said Dr. Dilip Karnik, a child

neurologist and medical director of the autism program at Dell Children's

Medical Center in Austin.

If there were evidence that the CARE Clinics' approach worked, " we would be

doing it, " he said. He said some children with autism do get better, some with

conventional treatment, some on their own.

The Thoughtful House Center for Children, which also is on Bee Cave Road and

treats children from around the world with autism, focuses on GI problems based

on a theory by Executive Director Wakefield that conventional doctors and

researchers also dispute. Unlike the CARE Clinics, Thoughtful House does not

bill insurance companies but leaves it to parents to seek reimbursement.

In Texas, no regulatory agency oversees such clinics. Complaints go to boards

that police doctors or nurses working in them. Caquias, who also practices in

Brownsville, has a medical board complaint pending against him. The complaint,

provided by Curtin, alleges without details " practice inconsistent with public

health and welfare — quality of care " and " non-therapeutic prescribing or

treatment. "

The medical board disciplined him in 2006 and 2007 for minor infractions

involving recordkeeping and promoting his affiliations with alternative medical

boards not recognized by the American Board of Medical Specialties.

The latest complaint " is false and malicious, filed by some unknown entity

intent on destroying CARE Clinics' alternative medical treatments of Autistic

children, " Caquias wrote to the board.

Caquias was among those who testified this month when the House Public Health

Committee aired House Bill 3816, which would curtail the powers of the Texas

Medical Board, the state agency that regulates doctors. Caquias, parents of

autistic children and others alleged that those who treat autism face

discrimination by the board and by insurance companies that don't want to pay

for the care.

They also accused insurers of filing anonymous complaints with the board to

trigger investigations of alternative medicine doctors — a charge the insurance

industry and medical board denied.

The medical board is driven by complaints and " does not target any particular

area of medicine, " said Mari , the board's executive director. Nor does

the board work with insurance companies to go after doctors, she said.

Ahrens, executive director of the Texas Association of Life and Health

Insurers, said the industry is not targeting alternative medicine doctors or

trying to get out of contracts to pay claims. " To say that insurance companies

are trying to get at doctors by making anonymous complaints is unfounded, " she

said.

Curtin blames a retired North Carolina psychiatrist, Dr. Barrett, for

instigating the medical board reviews through his Web site, Quackwatch. Last

year, Barrett posted an article on his site cautioning people to " Be Wary of

CARE Clinics " as well as a charity that Curtin also heads. He wrote that most of

the tests CARE Clinics conduct " have no proven relevance to autistic spectrum

disorders. "

Curtin said Barrett works for insurance companies and has been a witness in

court cases for them. She also accused him of filing the latest complaint

against Caquias.

Barrett wouldn't discuss the medical board complaint. He said he works

independently and is not paid by any insurance companies. He said he has

provided expert witness testimony a time or two, but " I have no financial

relationship with anyone who's after CARE Clinics. ... There's no conspiracy,

and I'm not a part of it. "

The Quackwatch article " is intended to make people think very seriously about

whether they should trust " the clinic, he said. " I've looked at what she's

billing insurance companies for, and no insurance company, in my opinion, would

knowingly pay for that stuff. "

Curtin provided copies of affidavits she said she's received from three of the

four patients (or their parents) named in the complaint against Caquias. She

also provided the names of other parents, who in interviews spoke highly of the

care their children received at CARE Clinics.

Dupont, 36, of El Paso said she starting taking her 6-year-old

daughter, Mia, to CARE Clinics a year ago and saw her personality start to

emerge by the second visit after her intestinal problems and other ailments were

treated. " She, for the first time, started looking at me, " Dupont said. " She

looked present. " She still has autism, " but people would not know she is

autistic unless I tell them. "

Marie Groover, 50, of Ashland, Ore., had a chance to take her 16-year-old son to

the clinic once last year and spent $3,000 to $5,000 on testing, she said. He

spoke his first words in a long time, she said. " For the (American Medical

Association) to insinuate that we're being taken advantage of is so wrong, " she

said.

Karnik urged parents to be cautious. Blood and urine tests don't tell what is

happening in the brain, he said.

Autism " must be managed by a brain scientist, " he said. " You've got to know the

brain, in and out. "