An Incident in Kodiak

In The Politics of Autism, I discuss interactions between police and autistic people.  Police officers need training to respond appropriately.  When they do not, things get out of hand.

In Anchorage, Samantha Angaiak reports at KTUU-TV:

Police reports, video and audio recordings obtained today through a public records request reveal new information about a controversial Sept. 16 encounter between Kodiak police and a man with autism.

The case led some community members here to accuse police of excessive use of force when they used "OC spray" -- or pepper spray -- to subdue and handcuff 28-year-old Nick Pletnikoff during a struggle. In newly released footage from police body cameras, Pletnikoff can be heard yelling "I want to go home!" as officers attempt to restrain him.

His mother said she was appalled by the footage.

...
No charges were filed against Pletnikoff once officers learned of his autism, police wrote.

Judy Pletnikoff tells Channel 2 her son was in the area attempting to check the mail before the encounter. She said he does not attempt break into cars, as police wrote, but simply looks at them.

In a statement describing the release of the records, the city of Kodiak writes: "The videos of the struggle between the officers and the (28-year-old0 may be uncomfortable to watch. However, we hope the viewers will understand there is more to the story than the media’s version that this young man was assaulted on his way to check the mail." 

 

Liz Raines reports at KTVA-TV:

The officers involved claimed they didn’t know 29-year-old Nicholas Pletnikoff is mentally disabled — though one of the officers later told the others he knew Pletnikoff had “special needs” before he was pepper sprayed.

A spokeswoman for the Anchorage Police Department, Renee Oistad, didn’t want to comment on how the Kodiak Police Department responded to the situation, but did describe APD’s general policies when detaining someone — which were very different from the behavior of Kodiak police.
...

In Anchorage, Oistad said police have a dialogue-first policy.

“It doesn’t matter who we take into custody, we always tell them what we’re doing and why — always,” Oistad said.
...

Oistad said learning to recognize someone with different mental abilities is one of the first skills officers are taught. Beyond that training, APD has a specialized group of officers known as the Crisis Intervention Team (CIT).

“These folks are also trained to recognize people that process information differently and are called out to scenes as opposed to having to go hands-on,” Oistad said.

Silver Alert in Alaska

A July 10 release from Alaska State Senator Johnny Ellis:

ANCHORAGE – Today, the Governor signed House Bill 59, creating rapid response and notification plans for law enforcement to activate when a vulnerable adult goes missing. The bill’s protections would apply to senior citizens with dementia, adults with developmental disabilities, veterans suffering from PTSD, and other disabled adults.

House Bill 59 was introduced by Representative Max Gruenberg (D-Anchorage). Senator Johnny Ellis (D-Anchorage) cross-sponsored the bill and was the prime sponsor of its Senate companion.

“Much like the Amber Alert helps find missing children, the Silver Alert can save lives by coordinating efforts to find seniors and vulnerable adults, should they go missing,” said Representative Gruenberg.

The bill received overwhelming support from public, senior, and disability advocates in the Legislature. Silver Alert supporter Michael VanVleet, a disabled Iraq War veteran who works at Ft. Richardson’s Warrior Transition Unit, said it was a much-needed tool to address the problem of veterans with Post-Traumatic Stress Disorder.

“Creating a ‘Silver Alert’ in Alaska has been a top priority for numerous organizations that represent seniors, veterans, and the disabled,” said Senator Ellis. “The only concern I ever heard about this bill is ‘Why the heck haven’t we done this already?’”

Alaska now joins thirty-eight other states with “Silver Alerts” or related programs with demonstrated success in improving the outcomes of missing person searches for vulnerable adults. Alaska has a particular need for a “Silver Alert” program, given the state’s harsh weather and vast wilderness, coupled with its large number of active military members and veterans, as well as a growing senior population.

The program will be designed by the Alaska Department of Public Safety, in cooperation with the Department of Military and Veterans’ Affairs, to best incorporate the voluntary cooperation of media outlets in notifying the public of missing vulnerable adults through television, radio, and social media.

Please call Rep. Gruenberg’s office at 269-0123 with any questions.

Insurance Day in Alaska

Previous posts discussed the mandate bill in Alaska. The Associated Press reports that its insurance provisions take effect today.

One of the new laws set to take effect in Alaska will require health insurance policies to cover treatment of autism spectrum disorders... A part of the autism bill took effect earlier, establishing a task force to study issues such as the state providing insurance coverage for the disorder.
...
Some insurance companies opposed the measure, saying it was unfair to put the burden on private companies.

However, Amy Carter, a spokeswoman for Premera Blue Cross Blue Shield, recently said the insurer expects rates to rise at a lower level than initially predicted.

Sen. Johnny Ellis, D-Anchorage, a primary sponsor of the Senate bill, said in an email that "the state has consistently adopted state-mandated coverage as part of its standard health plan for state employees," even though there was no requirement to do so.

"This has held true for coverage of breast cancer, prostate cancer screenings, well-baby exams and numerous other medical conditions," he said. "Insurance coverage for autism should be no different, and I would expect and hope this happens after the next round of labor contract negotiations."

Alaska Mandate Becomes Law

A press release from Alaska State Senator Johnny Ellis:

Senate Bill 74, which requires health insurance policies to cover treatment of autism spectrum disorders (ASDs), has been transmitted by the Governor back to the Legislature. The new law requires insurance coverage for ASDs including medically necessary treatments such as speech and language therapies, occupational and physical therapies, and behavioral interventions. Governor Sean Parnell chose to return the bill to the Legislature without his signature, which under Alaska law will result in enactment. A 20-day period, not including Sundays, for the Governor to sign expires June 27.

"I first introduced this legislation three years ago after meeting with a mother of a child with autism," said Rep. Pete Petersen (D-Anchorage), prime sponsor of the House version of this bill. "When I learned that children were being denied coverage for scientifically proven treatment that could help them lead a normal life, I knew we had to take action."

Senate Bill 74, approved by the Senate in February, was passed by the House on the last day of session after a few minor changes. Families of those affected by autism packed committee rooms and the hallways of the Capitol Building as Senate Bill 74 made its way through the process. Dozens of parents, experts and others testified in support of the legislation.

"Today, the families of autistic children in Alaska can celebrate a bill that will not only help children, I believe it will help save marriages and families," said Sen. Johnny Ellis (D-Anchorage), the prime sponsor of SB 74. "Children who receive these medical treatments have a shot at staying home and out of costly institutions where they would be destined to a life of constant and intensive care."

The Alaska Dispatch adds some detail:

The mandate, Parnell said, "will likely diminish the educational costs, medical costs, and increased lifelong productivity of many individuals, including family members, all interests beneficial to the State," Parnell wrote in a letter attached to the bill.

Although it doesn't need his signature to become law, Parnell didn't sign it because he still has concerns over the cost, his spokesperson Sharon Leighow said.

During testimony, insurance companies said premium costs for those who buy private insurance could be raised as much as 3 percent as a result of the mandate. A peer reviewed study, however, said that it would be much lower than that.

Mandate Bill Passes Alaska Legislature

The Alaska insurance mandate bill came back from the dead and passed the Legislature over the weekend.  AP reports:

The Alaska Legislature has passed a bill that would extend insurance coverage to some children for treatment of autism spectrum disorders.

SB74 passed the House 36-3 on Sunday. The Senate later agreed to the House changes.
The measure would require insurance coverage for medically necessary treatments for autism, like speech and physical therapies.

Some insurance companies opposed SB74, calling it unfair to put the burden on private companies alone. An amendment that would have had the state comply with the coverage requirements was withdrawn on the House floor.

Alaska Mandate Back from the Dead

At the Associated Press, Austin Baird writes that Johnny Ellis's SB74 may still pass after all:

Rep. Wes Keller still sees flaws in a bill that extends insurance coverage to some children for treatment of autism, but the chairman of the House Health and Social Services Committee said Friday that he plans to let the widely supported proposal move out of his committee.
...
Some insurance companies voiced opposition of the measure, and Keller sympathized with their claim that it is unfair to put the burden on private companies without extending the onus to the rest of the market. Premera Blue Cross-Blue Shield of Alaska has claimed a 3 percent increase of their premiums will likely occur, and they have said the bill only affects 15 percent of the market with the rest uninsured or covered under public plans.

Keller said after a hearing on the bill Wednesday that he was unlikely to let it through, but now six cross-sponsors of the bill are members of his committee. They and the bill's 29 overall cross sponsors in the House have won out.

He said Friday he has realized his position on the matter leaves him in a "pretty severe minority."
...
If everything goes as planned on Saturday, the bill will move to the Labor and Commerce Committee as scheduled. That committee could, however, waive the bill to ensure a floor vote takes place before session ends Sunday at midnight.

Read more here: http://www.adn.com/2012/04/13/2421995/keller-will-let-autism-insurance.html#storylink=cpy

Insurance Legislation

In Alabama, The Birmingham News reports on legislative action Tuesday:

Senators voted 32-0 for a substitute bill that directs insurance companies to offer plans that include coverage for autism treatment. Businesses could choose to offer the coverage as part of their insurance options for employees, or parents could pick it up as a rider, said sponsor Sen. Cam Ward, R-Alabaster.

Advocates originally were pushing a bill that would have mandated the coverage.

"I think it's a fair compromise. Is that everything we want? No," said sponsor Sen. Cam Ward, R-Alabaster. However, he said, "This provides more coverage than the autism community has ever seen."

In Alaska, AP reports:

Rep. Wes Keller, chairman of the House Health and Social Services Committee, said Wednesday that a bill requiring health insurance companies to provide coverage of top-notch treatment for autism spectrum disorders is unlikely to move through his committee this session.

At a hearing Tuesday, the back rows of the room were filled with the usual legislative staffers, but a crowd of activists, parents of kids affected by autism and a handful of children were also in attendance as part of an impassioned plea for the passage of SB74.

"This job is a heartbreaker," Keller said in an interview with The Associated Press. "With all that passion and feeling, it's easy to do something that's not effective, but this is a bad policy."

...

Some insurance companies voiced opposition of the measure, and Keller sympathizes with their position.

In West Virginia, WVNS-TV reports:

West Virginia University has one of the top doctoral training programs in behavior analysis in the country, yet there are only 28 Board Certified Behavior Analysts (BCBA) in our state.

The bills signed into legislation earlier this month not only makes treatment more affordable, it also makes West Virginia a more attractive place for analysts to work.

"Our surrounding states have had legislation that covers insurance for autism for awhile," said WVU Assistant Professor Claire St. Peter, Ph.D. "So when we were graduating students, well they were being drawn to other states."

WVU developed a Masters program in hopes of giving students the skills needed to combat the lack of autism services in rural areas but without insurance coverage, most of those students left the state.

"So we were graduating students who were from West Virginia, who wanted to stay in West Virginia, who couldn't just find a job because there was no coverage and the families couldn't afford it," St. Peter said.

In North Carolina, WSOC-TV reports on a proposed mandate.

Alaska Mandate Bill: A Hearing and a Setback

The Anchorage Daily News reports on an Alaska House hearing on autism mandate legislation:

Two of the witnesses, parents of children with autism, openly wept as they asked the committee to help save families by reducing the financial struggles they faced, even if they couldn't help with their emotional burdens.

One was BreeAnn Davis, a mother testifying by phone who said that if the bill didn't pass this year, it would be like a death sentence.

The other was a legislator more accustomed to being on the other side of the table, Rep. Dan Saddler, an Eagle River Republican who spoke of being forced to split up his family so his son could get autism treatment in a state with better facilities.

Five of the seven members of the Health and Social Services Committee are sponsors of the measure, but when the hearing ended, Rep. Wes Keller, R-Wasilla, its chairman, said he would hold the bill and gave no indication of when -- or if -- he would bring it up again.

KTUU-TV offers more (VIDEO HERE):

A bill that would mandate autism insurance in Alaska suffered an unexpected setback Tuesday night, when House Health and Social Services Committee Chair Rep. Wes Keller (R-Wasilla) decided to keep the measure bottled up in committee -- leaving parents of autistic children deeply disappointed.

With just five days left in the regular session, it is now extremely unlikely that Senate Bill 74 -- which would require insurance companies writing policies in Alaska to provide coverage for autism -- will see the light of day this session.

The measure is not dead, but it's on life support.

Backers' mood Tuesday was one of "shock" and "deep disappointment" according to Beth Richardson, the mother of a 6-year-old who has benefited greatly from early detection and treatment of autism. Statistics show that 50 percent of all children diagnosed with the disease can attend a regular first-grade class rather than special education.

Alaska: Gumballs and Insurance

KTUU-TV in Anchorage reports that the Alaska House has just 15 days to act on Senate Bill 74, an insurance mandate. 

Sen. Johnny Ellis (D-Anchorage) says that over the course of a lifetime, early diagnosis and intervention in autism can save the state more than $200,000 in special-education costs, and millions more over the lifetime of someone who suffers from the disorder. That's because intervening early -- before the neural pathways of a child's brain have fully formed -- can disrupt much of the asocial behavior of a child with autism.

Six-year-old Mhina Richardson of Juneau would seem to be living proof of the benefits of early intervention. A year and a half ago, she was diagnosed with autism. Her mother, Beth, took her to therapists. Today, to an outsider, she looks and acts like any healthy, happy 6-year-old. Her mom can still tell that Mhina has challenges, but she also insists the early intervention made a big difference.

"She's doing really well now," Beth Richardson said.

On Friday, Beth, Mhina and perhaps a dozen other people toured the state Capitol handing out gumballs to lawmakers. Their point was that for the price of those gumballs, every child in our state can be insured for autism treatment.

They are urging that lawmakers hold hearings on Senate Bill 74, and their requests have finally been heard. The House Health and Social Sciences Committee announced Friday that it would hold hearings on the measure within the next 10 days.

Action on Alaska Mandate

A previous post dealt with a proposed mandate in Alaska. AP reports:

The Alaska Senate has passed a bill requiring insurance coverage for autism spectrum disorders.

SB74 passed 14-5 Wednesday. Minority Leader John Coghill served notice of reconsideration, meaning the bill could be voted on again before going to the House. 

Coghill was among the dissenting votes. He had tried unsuccessfully to amend the bill to replace the coverage mandate.

Sen. Johnny Ellis, the bill's lead sponsor, said the amendment would render the bill essentially toothless.

Autism Speaks supports the bill, which Senator Ellis described on the floor:

 

Mandate Proposal in Alaska, and the Cost of Autism

In the Anchorage Daily News, Alaska state legislator Pete Petersen makes a case for his insurance mandate legislation: "If children receive intervention treatment before the age of 4, many of them go on to live productive lives comparable to those without a developmental disability. It is projected that nearly $3.2 million in social service costs per person can be saved over their lifetimes with effective early treatment."

Early intervention does pay long-term dividends, but there are a couple of problems with this specific claim.

The figure of $3.2 million apparently comes from the work of Michael Ganz of the Harvard School of Public Health: "the total annual societal per capita cost of caring for and treating a person with autism in the United States was estimated to be $3.2 million and about $35 billion for an entire birth cohort of people with autism." But when Ganz writes of "societal per capita cost," he is not just talking about "social service costs." He explains that it includes much, much more:

The total costs of autism equal the sum of its direct and indirect costs. Direct costs measure the value of goods and services used and indirect costs measure the value of lost productivity due to autism. These direct and indirect costs represent the value of other activities that these resources could have purchased (i.e., opportunity costs). Physician and other professional services, hospital and emergency department services, drugs, equipment and other supplies, and medically related travel and time costs are typical components of direct medical costs. Direct medical costs were obtained either from the literature or from an analysis of the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS). Special education, transportation, child care and babysitting, respite care, out-of-home placement, home and vehicle modifications, and supported employment services are typical components of direct nonmedical costs. Nonmedical costs were obtained from the literature. Multiple cost estimates within categories were averaged to obtain a single cost estimate for each category. Indirect costs are the value of lost or impaired work time (income), benefits, and household services of individuals with autism and their caregivers because of missed time at work, reduced work hours, switching to a lower-paying but more flexible job, or leaving the workforce. Indirect costs were computed using a human capital approach that combines average earnings, benefits, and household services with information on average work-life expectancies and labor force participation rates for men and women at different ages.

Second, saving the $3.2 million is possible only when the treatment is so totally effective that the autistic person needs no further intervention, ever. That assumption is highly optimistic.

Again, advocates are wise to point out the cost-effectiveness of early intervention. But they should take care not to overstate their case or distort the data.