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Kaiser Defends Mental Health Coverage As 'team-Based'

LOS ANGELES, Apr 14 (Reuters) - Kaiser Permanente, under investigation in California for requiring psychiatrists to write drug prescriptions for mental health patients whom they have not seen, on Thursday defended its practice as "team-based."

The California State Department of Corporations is investigating Kaiser, the nation's largest nonprofit health maintenance organization, after a complaint from a psychiatrist who alleges that he was fired for refusing to write prescriptions for patients he had not examined. "The model used in the Kaiser Permanente San Diego department of psychiatry is a team-based approach to providing quality mental health care services to health plan members," Dr. Joel Hyatt, assistant associate medical director of Kaiser's Southern California medical group, said in a statement.

"We believe that some who have expressed concern about our practice are not fully aware that our patients are very carefully screened, that this represents a carefully structured process designed by physicians, and that all decisions €” to examine the patient or to prescribe medication €” are made by physicians," Dr. Hyatt said.

The California department, which regulates managed care, has said that it plans to hold an inquiry into the matter.

The complaint, filed by San Diego psychiatrist Dr. Thomas Jensen, alleges that, as a matter of practice, psychiatrists are required by Kaiser to prescribe medications for depression and anxiety on the recommendation of nonmedically qualified personnel, such as psychotherapists, social workers and even intern social workers, without ever examining the patients. Dr. Hyatt said that Kaiser's new patients are carefully screened by a licensed clinical social worker, licensed family therapist or clinical psychologist. A psychiatrist then reviews the assessment, and, in cases where a patient is presenting with mild depression or anxiety, the psychiatrist might prescribe a starter dosage of appropriate medication and then personally examine the patient in about 3 to 4 weeks. "The personnel who conduct the initial assessment are licensed mental health professionals who work closely with the psychiatrists in their unit. They do not prescribe independently, and do not make diagnoses or prescribing recommendations to the psychiatrists," he said. Dr. Jensen has also filed a lawsuit in Alameda County Superior Court in northern California, where Kaiser has its headquarters, seeking an injunction to force the company to end the practice. Dr. Jensen told the Los Angeles Times that on his first day at work with Kaiser, he was presented with cases by social workers, social work interns and marriage and family therapists who recommended drug treatments for patients they had diagnosed.

According to California law and the American Psychiatric Association code of ethics, the prescribing of drugs by a physician without "good faith" prior examination by that physician is classed as "unprofessional conduct."

Copyright 1999 Reuters Ltd. All rights reserved.

Kaiser Ends Medication Policy May 5, 2000

LOS ANGELES (AP) - Health maintenance organization Kaiser Permanente has ended a policy that requires psychiatrists to prescribe depression and anxiety medications for patients they haven't examined.

Kaiser psychiatrists must now rely on their own examination of patients before writing prescriptions, the HMO announced Tuesday.

Kaiser is the nation's largest not-for-profit HMO, serving 8 million members in 11 states and the District of Columbia. Almost 6 million of its patients are in California.

A former Kaiser psychiatrist, who said he was fired for not following the old policy, filed a lawsuit last month that drew national attention and prompted the state Department of Corporations to begin investigating the drug practice.

The lawsuit, filed by Dr. Thomas S. Jensen of San Diego, sought to halt Kaiser's prescription policy, which were often delivered at the behest of social workers or family therapists.

Critics said prescriptions from absentee psychiatrists endanger mental patients and violate ethics codes of the American Psychiatric Association.

Dr. Oliver Goldsmith, medical director for Southern California Permanente Medical Group, said Tuesday the HMO decided to review its policy amid the public outcry.

"The public attention was a stimulus for us to take another look at this practice," Goldsmith said. ``We felt that this was a street we had to come back from."

However, Goldsmith maintained no patients were harmed by the previous policy, which was restricted to Kaiser's psychiatric clinics in the San Diego area. About 24,000 patients were treated there last year, he said.

Kaiser acknowledged its old policy differed from standards generally accepted by the psychiatric community, but said the practice was designed to allow psychiatrists to treat more patients.

Jensen's attorney, Cliff Palefsky of San Francisco, cautioned that his client would not drop the lawsuit against Kaiser until he sees changes that are "real and complete."
Meantime, a spokeswoman for the Department of Corporations said the agency intends to continue its investigation.

Kaiser Papers