The class action suit was brought by three of the health plan's members, who all use wheelchairs, who complained that inadequate facilities in doctors' offices prevented disabled patients from receiving adequate medical care. Although the lawsuit's plaintiffs all are mobility-impaired, the settlement covers patients with cognitive impairment, hearing, vision, and other sensory disabilities.

The complaint alleges that Kaiser "disciminates against Plaintiffs . . . on the basis of disability by failing to provide accessible facilities, examination tables, scales, and other types of medical equipment and services." For example, the lawsuit says, people in wheelchairs have trouble using standard, 33-inch-high examination tables, and says Kaiser should use wheelchair-friendly examination tables that allow the wheelchair user to get on and off the table with little assistance.

The settlement covers medical equipment and "virtually every other aspect of health care to people with disabilities," says Alison Aubry, staff attorney for Disability Rights Advocates, which represented the plaintiffs in the lawsuit. Kaiser has agreed to conduct a systemwide survey of its 26 hospitals and 120 medical office buildings in California to identify barriers to access for disabled patients, then redesign the buildings to accommodate those patients.

The HMO also will evaluate its medical equipment and purchase accessible equipment for doctors' offices, and hire an "access consultant" who will review Kaiser's policies and procedures to determine whether they discriminate against people with different types of disabilities.

In addition, the Kaiser hospitals in San Francisco and Riverside will become "model facilities" for disabled access, the first systemwide to try out different programs for accessibility to determine what policies and equipment best meet disabled patients' needs.

Neither side has put a price tag on the settlement, but Kaiser has promised to completely overhaul the way it accommodates disabled patients within five years.

"Money hasn't been an issue with us. We just decided that this is the right thing to do," says Tom Debley, media relations director for Kaiser's California division. Debley says the company annually allocates "tens of millions of dollars" across California for new construction and remodeling efforts, and that the renovations to make buildings more accessible to disabled patients will be paid for with that money.

Kaiser does not know how many of its members are disabled. "There hasn't been any reason to track that information, but we think it's a good thing to do," Debley says. "That will become part of this process to get a better understanding of how we can help members on the front end, well beyond just providing physical access. We want to look at this across the spectrum, including hearing, sight, and other types of disabilities."

"This is a problem that is pervasive throughout the health care industry, and it's not just limited to Kaiser," says Aubry. "We receive complaints from people with disabilities who have different HMOs, who see a range of health care providers, and it's very common that people with disabilities will receive inferior care and encounter a range of barriers within the health care system. It's our hope that this settlement will be a model that other health care providers will look to."

The settlement is legally limited to California, but Kaiser says it will implement similar programs to help disabled patients in the other states where it does business. Kaiser also operates in Colorado, the District of Columbia, Georgia, Hawaii, Maryland, Ohio, Oregon, Virginia, and Washington.