In the early 1970s, Capitol Hill took notice when print and broadcast journalists exposed deplorable conditions — neglected children living in filthy conditions — at Willowbrook State School, a New York state-run institution for the intellectually disabled. The scene prompted Congress to create a nationwide “protection and advocacy” system.

The Developmentally Disabled Assistance and Bill of Rights Act, enacted in 1975, provided for the governor of each state to designate an independent watchdog. Tapped to serve in that role here is the Hawaii Disability Rights Center (HDRC), which is governed by a board representing a cross section of the disability community.

“We want people in the disability community to feel that they have a friend, a voice, and a go-to place” at the center in downtown Honolulu, said Louis Erteschik, the nonprofit corporation’s executive director.

Last month, HDRC filed a lawsuit in federal court against the state departments of Education and Human Services, contending they’re sidestepping responsibility under the federal law to see to it that students with autism get Applied Behavior Analysis (ABA) services from qualified therapists during the school day without having to leave campus.

The lawsuit maintains that while there were more than 1,900 students with autism enrolled in public schools, except in rare cases, ABA services are not folded into student education plans.

Previously, HDRC sued the state in 2014 on behalf of a 5-year-old boy diagnosed with severe autism spectrum disorder and the boy’s mother, who was forced to pay out of pocket after the DHS denied her Medicaid coverage for the services.

The parties settled the case last year after the DHS agreed the services were covered by Medicaid.

“These few lawsuits we file are really the rarity. Most of the time, something can be negotiated” on behalf of a client, said Erteschik, a Brooklyn, New York native who has worked as a public interest lawyer since the mid-1970s. He has held the top post at the center for seven years.

While not every workday is upbeat, the job can yield satisfying results. “Most of our calls come from people being denied a service they feel they should get. … There’s usually a problem.”

Still, he added, “When I look at some of the cases that we’re doing, like autism issues. I think we can say that there could be a whole generation of kids that grow up here that are going to get better treatment and better results because of the work that we’re doing. That’s the kind of stuff that keeps me going.”

Question: What prompted the current lawsuit regarding autism services in public schools?

Answer: The incidence of autism has really been on the rise in recent years. (About 1 in 60 children have the disorder, according to the Centers for Disease Control and Prevention.) ABA services (one-on-one therapy, up to 40 hours weekly) can, in some cases, bring about a full level in functioning.

ABA is considered a medical service under EPSDT. (Early and Periodic Screening, Diagnostic and Treatment is the child health component of Medicaid.) It’s also considered an educational service under special education — under the Individuals with Disabilities Education Act.

Medicaid would pay for credentialed professionals to come into the schools and work with kids during the school day … but the the schools have generally been resistant. (In response to the lawsuit, the DOE issued a statement saying it provides its students all services deemed appropriate and necessary, including Applied Behavior Analysis.)

We take the view that the DHS, as the state Medicaid agency … is obligated to provide services. And if the DOE is standing in the way, then DHS has got to lean on DOE a little bit more.

… The legal argument is the ADA (Americans with Disability Act, 1990) argument. If a child needs to get a medical service in the school, then this would be a reasonable accommodation that they’re entitled to. The problem is that, basically, families are being forced to choose between having their autistic kids go to school or get services they need.

Q: How has the protection and advocacy system evolved in Hawaii?

A: We were designated by George Ariyoshi when he was governor, and once you’re designated, it’s pretty hard to get un-designated. The law specifically says you can only be redesignated for good cause. … Zealous advocacy is not considered cause for redesignation.

Initially, the system was for people with developmental disabilities, which includes intellectual disabilities. (In subsequent decades, the scope was expanded to include physical disabilities, traumatic brain injury, mental illness and issues such as voting accessibility.)

We have a lot of different functions. In our monitoring function, we can just go to any facility where a person with a disability is getting treatment. We can go into residential care homes and group homes unannounced.

Q: How many people in Hawaii have disabilities, as defined by federal law?

A: Generally, about 15 percent of the population.

Q: Given the so-called “silver tsunami” forecast, your potential client count will go up?

A: If we all live long enough, eventually we’re going to become people with disability. … You’re going to have physical issues and/or cognitive issues. There’s a lot of overlap between HDRC programs and those for the elderly, through the Older Americans Act (1965). (It supports home and community-based services, ranging from nutrition programs like meals-on-wheels to elder abuse prevention.)

Q: How does funding for HDRC services work?

A: All services provided by the center are free, and most of HDRC’s annual budget, which is generally flat-leveled ($1.5 million to $2 million) is covered by federal funding. We’ve done well with both Democratic and Republican administrations … disabilities, and related compassion, cut across political lines.

Q: In recent decades, due to high court decisions such as Olmstead v. United States (1999), more people with disabilities are receiving supports and services in the community rather than in institutions. What has that meant for Hawaii?

A: Olmstead is a sort of hallmark of the disability movement. It was a U.S. Supreme Court case that said: Assuming your physician recommends it, you can live in a least-restrictive environment. … That was a pretty huge victory for people with disabilities because previously a lot of the funding streams only supported them in institutional settings.

That was kind of ridiculous because … it’s actually cheaper, typically, to support somebody out in the community instead of in an institution. And the quality of life is usually better. You’re more integrated, you can hang out with your friends, go to church, go to the ball game.

Community integration has come a long way. We’ve done a pretty good job in Hawaii. When I first moved here, they were closing Waimano Home. (Established in 1919 as Waimano Home for the Feebleminded, the facility was shuttered in 1999.) Now we have no DD (developmentally disabled) institutions, and we have a pretty good network of these care homes where people can reside in the community.

Q: It’s evident that many people in Hawaii’s homeless population are grappling with mental illness. The least-restrictive effort is going less smoothly for this group?

A: When Linda Lingle was governor, mental health community-based services were cut. … We’re now reaping the effects of that. Absolutely. That’s where they did Olmstead kind of wrong. … You have to deliver on the back end.

(Through the Lingle administration’s 2009 budget cuts initiative, the state Heath Department lost hundreds of positions and was forced to cut funding to dozens of nonprofit services providers that handled much of the case-management duties for Hawaii’s severely mentally ill.)

Q: Does HDRC have legislative priorities it wants to see the 2019 Hawaii Legislature address?

A: We’re not allowed to lobby, but we can educate policymakers. Whether to eliminate the sub-minimum wage will probably be an issue in the session. (A provision in federal law permits employers to apply for a waiver to pay lower wages to people with disabilities.)

Some people think it’s a vestige of a past time, and I understand that. At the same time, it’s probably true that many wouldn’t be employed otherwise. That may not be politically correct to say, but it’s the honest truth.