The Rise and Fall of CARE Clinics and the
Center for Autistic Spectrum Disorders (CASD)

Stephen Barrett, M.D.

The Center for Autistic Spectrum Disorders (CASD) was founded in 2001 by Kazuko Curtin. Curtin also did business as CARE Clinics at the same address in Austin Texas. Clinic literature stated that she became interested in "biomedical treatments" when her 2-year-old son (now a teenager) was diagnosed with autism [1]. CARE opened a second clinic in Tampa, Florida in September 2008. However, legal troubles that began shortly afterward led to the closing of both facilities in 2009. This article describes the history of CARE Clinics and the events that led to the closings.

"Biomedical Treatment"

Biomedical treatment for autism is said to correct "biochemical imbalances" and provide "detoxification." [2] It is aggressively promoted through Web sites, blogs, and conferences and by posts on at least five Yahoo newsgroups that in 2008 had from 4,000 to 13,000 members. CARE Clinics was the lead sponsor of the National Autism Association's 2008 National Autism Conference [3].

In 2008, CARE's Web site stated:

Children with autism commonly have certain genetic predispositions, nutritional deficiencies, immune system compromises, and toxic overloads. To best address these challenges, CARE Clinics develops a personalized care plan which when used over time, cumulatively works to heal each child [4].

and

CARE NutriGenomics provides personalized advice beyond diet, including supplementation and even life style advice based on your assessed Biomarkers, including the genomic valuations that we determine at CARE Clinics. The technology of health science is quickly improving, however, before CARE Clinics, the clinical use of Biomarkers and Nutrigenomics have not yet begun to be sufficiently used for the recovery of our children. In the treatment of cancer, Alzheimer’s, anti-aging, and some other conditions, BioMarkers have already been introduced and are making progress. Here at CARE Clinics, we have been successfully treating children by using the latest medical diagnostic technique, CARE Clinics BioMarkers™ to design your child’s CARE Clinics Health Blueprint™ and create an individualized treatment plan [5].

CARE literature claimed that its Biomarkers evaluation "helps to identify subtle abnormalities that may prevent the ability to achieve optimal health" and is the "most comprehensive lab testing available." The evaluation includes genomic testing, various routine blood tests; and tests for amino acids; organic acids; peptides; uric acid; oxalates; metallothionein; melatonin; iodine; kryptopyrrole; essential fatty acids; neurotransmitters; oxidative stress; vitamins and minerals; heavy metals; food allergies; inhalant and mold allergies; viruses; bacteria; intestinal permeability, and thyroid function [1]. These tests, most of which are nonstandard, have no proven relevance to autistic spectrum disorders.

All patients underwent a provoked "urine toxic metals test" in which a urine sample is obtained after the patient receives a chelating agent. The chelating agent temporarily increases the excretion of mercury, lead, and/or other metallic substances that are present in trace amounts within the body. The test report, which typically states that the reported levels are elevated, is then used to claim that the child needs to be "detoxified" with chelation therapy [6].

In 2008, the minimum charge quoted for people without insurance was $8,500 for the CARE BioMarkers evaluation plus $500 for a "first-time patient fee." The charges for insured care, however, were much higher. In one case I investigated, the insurance company received bills for screening tests totaling approximately $49,000 for the child and $41,000 for the mother! The records subsequently obtained by the FBI indicated clear-cut fraud because most of the tests that were billed for were not done.

CARE's "personalized" treatment plan was said to include amino acid therapy; vitamin, mineral, and antioxidant supplementation; intravenous nutrient therapy; "IV detoxification" (chelation therapy); diet modification; hyperbaric oxygen; ultraviolet light therapy; far infrared sauna; steam ozone sauna; and gastrointestinal treatments (enzymes, probiotics) [1]. CARE's guidebook listed more than 50 "supplements" that might be recommended [1]. None of these modalities has any proven benefit or plausible rationale for treating autism.

The labs processing CARE's tests included Doctors Data, Genovation, and The Great Plains Laboratory. The Hopewell Pharmacy and Compounding Center (Hopewell, New Jersey) provided some of the supplement products.

Genetic Testing

The centerpiece of CARE's evaluation was said to be genetic testing performed by Genova Diagnostics (formerly called Great Smokies Diagnostic Laboratory) of Asheville, North Carolina. The tests were claimed to identify genetic data associated with the development of various diseases so that nutritional strategies could reduce the chances of developing those diseases later in life. This concept, while appealing, has no validity and has never been demonstrated to work [7,8]. The test reports themselves included this disclaimer:

This test has been developed and its performance characteristics determined by Genova Diagnostics, Inc. It has not been cleared or approved by the U.S. Food and Drug Administration. Commentary is provided to the practitioner for educational purposes, and should not be interpreted as diagnostic and treatment recommendations. Diagnosis and treatment are the responsibility of the practitioner. Any positive findings in the patient's test indicate genetic predisposition that could affect physiologic function and risk of disease. We do not measure every possible genetic variation. The patient may have additional risk that is not measured by this test. Negative findings do not imply that the patient is risk.

In other words: "We'll be happy to pocket the money for providing the test report, but don't hold us responsible for anything it says."

Even worse, the tests did not even appear to be related to autism. CARE's "information guidebook" included a sample "DetoxiGenomic Profile" report for a 7-year-old boy, which advised that he have a comprehensive cardiovascular assessment, including an evaluation for high blood pressure [1]. Reports I have seen on another young child include discussions of "health implications" and "treatment options" related to cholesterol regulation, high blood pressure, and blood clotting. None of these conditions had any relationship to the children's actual health or could possibly influence their autistic behavior.

CARE Staff Members

In 2008, CARE Clinic literature included the following members of its "professional team":

How "Charitable" Was CASD?

CASD was a 501(c)(3) nonprofit corporation that represented itself as a charitable organization. To be tax-exempt under section 501(c)(3) of the Internal Revenue Code, an organization must be organized and operated exclusively for exempt purposes set forth in section 501(c)(3), and none of its earnings may inure to any private shareholder or individual. The exempt purposes set forth in section 501(c)(3) are charitable, religious, educational, scientific, literary, testing for public safety, fostering national or international amateur sports competition, and preventing cruelty to children or animals. The term charitable is used in its generally accepted legal sense and includes relief of the poor, the distressed, or the underprivileged; advancement of religion; advancement of education or science; erecting or maintaining public buildings, monuments, or works; lessening the burdens of government; lessening neighborhood tensions; eliminating prejudice and discrimination; defending human and civil rights secured by law; and combating community deterioration and juvenile delinquency [13].

CASD's federal tax returns indicated that during 2003, its program services consisted of Curtin's reading program and from 2004 onward it consisted of "special testing" for children with autism. They further stated:

The testing of autistic children is consistent with our mission of providing services to families with autistic children and to the medical professionals that care for these children. Our testing also serves as an educational service in that the parents are educated on the results of the testing, which better prepares them to care for their autistic child.

The tax returns for the years 2004 through 2007 indicated that a total of $8,324,010 was delivered as "program services" in the form of 28,710 tests for 2,027 children. The returns also stated that CASD received $8,734,285 as income from its program services [14]. If I understand correctly, the numbers meant that families (or their insurance companies) paid about $8.7 million for tests.

Data from CASD Form 990 Tax Returns

Category

2003

2004

2005

2006

2007

Gross receipts $141,336
$223,415
$744,122
$1,822,067
$6,504,391
Expenses: management and general $58,373
$61,074
$180,167
144,446
Fundraising expenses $6,375
$32,413
$86,188
0
0
Laboratory expenses  
$12,236
$315,530
$1,701,038
Program service income from testing  
$59,044
$744,122
$1,822,067
$6,498,743
Program services $17,035
$54,639
$507,067
$1,257,913
$6,109,052
    Number of children tested  
427
150
150
1,300
    Number of tests  
1,710
2,500
2,500
22,000
Net income from special events (conferences) $65,538
$71,776

Compensation, Kazuko Curtin
     as officer/director of CASD
     as independent contractor






$30,122



$203,833



$62,401

Loan to Nutrigenomics to
     purchase laboratory equipment
  $84,000

Other documents I have collected indicate that when services were rendered to insured patients, some claims were sent from CARE and some from CASD, both of which received payments from insurance companies. I don't know what percentage of their combined income was reported as "program service income" on the Form 990s. Regardless, I doubt that that selling medical tests was a charitable purpose. On May 15, 2011, CASD's tax-exempt status was revoked for failing to file tax returns for 2009, 2010, and 2011. [Note: The Center for Autism Spectrum Disorders in Vestal, New York, has a similar name but is respectable.]

In January 2009, Curtin announced that the Austin clinic would stop providing medical treatments in January and part of February in order to respond to requests by insurance companies for over 2,000 patient records. She also said that the staff needed time to enable its Web site to provide more information for patients. In May 2009, a newspaper article quoted Curtin as saying that Aetna had stopped paying and was questioning $1 million in claims and that Cigna and United Healthcare were also disputing claims. To cope with the paperwork and loss of cash flow, she said, the Austin Clinic would be open only 10 days a month and the Tampa Clinic was temporarily closed. Curtin also indicated that the Texas Medical Board was investigating a complaint against Dr. Caquias that involves "practice inconsistent with public health and welfare—quality of care" and "non-therapeutic prescribing or treatment." [15] In July 2009, the Austin-American Statesman noted that FBI and the Internal Revenue Service had raided the clinic and that it was closed [16].

In February 2009, the U.S. Court of Federal Claims announced that it had found no link between autism and vaccination. In a stunning trio of decisions, Special Masters concluded that no credible evidence exists that MMR (measles/mumps/rubella) or thimerosal-containing vaccines can combine to to cause autism. The decisions completely debunked these notions and implied that doctors who misdiagnose heavy metal toxicity and purport to "detoxify" autistic patients are unscientific and unethical [17]. CARE Clinics and its doctors were not parties in the proceedings and were not mentioned in the decisions, but the court's reasoning and conclusions apply equally well to all providers who routinely chelate autistic children.

More Legal Troubles

In July 2009, a civil suit for fraud, negligence, and conspiracy was filed against CARE Clinics, Curtin, Caquias, Baker, and Chicago-based Doctor's Data, the lab that performed urine toxic metal tests. The plaintiff, 43-year-old Ronald Stemp, charged that he was improperly diagnosed and treated over a 10-month period. The suit petition stated that Stemp originally sought help for memory loss, inability to sleep, difficulty concentrating, and depression. After going through a battery of tests, he was told that he suffered from heavy metal poisoning and should undergo intravenous chelation therapy 2-4 times a week. The chelation caused Stemp to feel nauseous, lethargic, depressed, constantly drowsy, and weak. He subsequently learned that the diagnosis was incorrect and that the urine test used to diagnose it was a fraud. Stemp's insurance company was reportedly billed for a total of $180,000 [18].

In September 2009, Doctor's Data sued Curtin for defaulting on payments for lab tests ordered through Nutrigenomics. The claimed amount was $286,649.39 plus interest and attorneys fees [19]. After Curtin failed to respond on time, the Court awarded $298,290.71 plus $6,376.03 for attorneys fees.

Current Status

In February 2011, Curtin referring to herself as Kazuko Grace) announced the "grand opening" of the Personalized Medical Center for Autism and Chronic Illness in Santa Monica, California. Other sites identified David Denton Davis, M.D. as its medical director, but I could find no details about its offerings. Searching with Google in January 2013, I could find no mention of her current activities.

References

  1. CARE Clinics Information Guidebook, Volume III: Putting Our Children on the Road to Recovery. Austin, TX: CARE Clinics, 2008.
  2. Vatakar B. What is biomedical treatment? The Journal of ASA Broward, March 2006.
  3. National Autism Conference Web site, accessed Nov 23, 2008.
  4. Announcement for CARE Clinics workshop on the biomedical approach to autism, scheduled for Nov 14, 2008 in connection with the National Autism Association's 2008 National Autism Conference.
  5. CARE Clinics home page, accessed Nov 24, 2008.
  6. Barrett S. How the "urine toxic metals test" is used to defraud patients. Quackwatch, April 29, 2009.
  7. Barrett S. Hall H. Dubious genetic testing, Quackwatch, Nov 24, 2008.
  8. "Genovations" genetic test kits. GeneWatch UK, July 2002.
  9. Curtin K. Visual learning aid system and method. Application filed Feb 22, 2001.
  10. Complaint. In the matter of the complaint against Jesus Antonio Caquias, M.D. Before the Texas Medical Board, signed March 31, 2010.
  11. Proposal for decision. Texas Medical Board v. Jesus Antonio Caquias, M.D.. SOAH Docket No. 503-10-3509.MD, filed Aug 3, 2012.
  12. Final order. In the matter of the complaint against Jesus Antonio Caquias, M.D. Before the Texas Medical Board, Nov 30, 2012.
  13. Exempt Purposes - Internal Revenue Code Section 501(c)(3)
  14. CASD Form 990 tax returns for 2003, 2004, 2005, 2006, and 2007.
  15. Roser MA. Insurance companies question autism clinic's charges: Owner of clinic, which uses controversial therapies, says she's had to lay off staff, cut hours. Austin American-Statesman, May 3, 2009.
  16. Roser MA. Austin clinic aided by federal authorities. Austin American-Statesman, July 15, 2009.
  17. Barrett S. Omnibus court rules against autism-vaccine link. Autism Watch, Feb 14, 2009.
  18. Plaintiff's original petition. Ronald and Carrie Stemp v. CARE Clinics et al. District Court, Travis County, Texas, cause no. 1D-1-GN-09-00279, filed July 16, 2009.
  19. Complaint for enforcement of personal guaranty. Doctor's Data vs Kazuko Curtin. U.S. District Court for the Northern Disrict of Illinois. Case 1:09-cv-05924, filed Sept 24, 2009.

This article was revised on January 3, 2013.

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