BC court wades into medical-necessity debate over autism treatment

The British Columbia Court of Appeal has upheld a ruling that the province violated the Canadian Charter of Rights and Freedoms by refusing to fund an early-intervention treatment program for autistic children. The treatment costs about about $60 000 per child per year (CMAJ 2000;163[9]:1181).

Parents of autistic children filed their suit in 1998, and 2 years later a BC Supreme Court judge declared the treatment — Lovaas therapy — medically necessary. The province appealed, but last month's unanimous appeal court ruling concluded that autism “is a medical disability just as cancer is, and both require treatment.” The court rejected the government's claim that it was unable to pay for the treatment and also changed the maximum age for eligibility from 6 years to 19 years. It is estimated that there are 1400 autistic children under age 19 living in BC.

Michael Lewis of the BC Autism Society praised the court for a “very, very strong judgement.” Sabrina Freeman of Families for Early Autism Treatment of British Columbia says that group is “extremely happy” with the judges' assertion that intensive behavioural therapy is “the only effective treatment for autism.” Freeman says the judgement has important national implications because Alberta, Quebec, Nova Scotia, New Brunswick and Ontario are currently involved in litigation regarding autism treatment. Only Prince Edward Island funds Lovaas treatment to age 19.

Freeman remains skeptical about whether the government will comply with the decision. “I firmly believe that it will be appealed to the Supreme Court of Canada,” she says. The province has not confirmed this.

Although the province appealed the 2000 ruling, it did begin providing parents of 500 autistic children under age 6 with $20 000 each in annual funding, says Freeman. Under that program, parents become eligible for funding if they have 2 letters from a family doctor, pediatrician or psychologist. They then have to hire a Lovaas therapy consultant, who creates a treatment program and trains a team of about 5 therapists to work with the child for 4 to 9 hours weekly. The therapy involves intensive work in language, socialization and behaviour.

Dr. Melvin De Levie, a Vancouver pediatrician who diagnoses about 30 cases of autism a year, says parents “still have to scramble” in a patchwork system once a diagnosis is made. Although he is pleased with the “very decisive” court decision, he says BC faces a problem because it has no education program for Lovaas therapists: “We need to develop our own resources.” — Heather Kent, Vancouver