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HEALTH–State Investigates Kaiser’s Psychiatric Prescription Policy



Women’s Health Company Strikes Two

E-Commerce Deals

Kaiser Permanente, California’s largest health maintenance organization, is presently under investigation by the state Department of Corporations for allowing its psychiatrists to routinely prescribe psychiatric drugs to mental health patients without having personally examined them. Some professionals contend the practice is unethical and potentially dangerous to patients’ health.

Julie Stewart, assistant commissioner for public affairs at the Department of Corporations in Sacramento, said the investigation was prompted by several complaints.

The spokeswoman declined to discuss details, but confirmed a recent Los Angeles Times article which stated the complaints were based on information from Dr. Thomas S. Jensen of San Diego, a former Kaiser psychiatrist.

Jensen, who filed a lawsuit last week, was reportedly fired by the HMO for refusing to prescribe medications for patients whom he did not personally examine.

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The American Psychiatric Association code of ethics declare that prescribing medications without a “good faith” prior examination is unprofessional conduct.

Jim McBride, a spokesman for Kaiser Permanente in San Diego, acknowledged that Kaiser’s policy may raise concerns with people who are unfamiliar with it. But he refuted contentions that the practice is unethical, arguing that doctors make decisions based on Kaiser’s unique “team approach.”

Under the Kaiser practice, new mental-health patients are screened by a licensed clinical social worker, family therapist, psychiatric nurse or psychologist, he said.

A psychiatrist reviews the assessment, and in cases where patients appear to have mild depression or anxiety, prescribes a starter dosage of the appropriate medication, he said.

The patient is then given a follow-up appointment with a psychiatrist in three to four weeks.

Some San Diego psychiatrists, however, said Kaiser’s policy of allowing non-physicians to examine first-time patients and recommend treatment is inadequate care.

“I think the standard of care is psychiatrists examine patients before they prescribe medications,” said Dr. Stephen Heidel, president and CEO of HHRC/Integrated Insights of San Diego, which provides employee assistance programs and work-life services to employers.

“I adhere to that myself and there is strong support among the psychiatric community that it should be the standard of care,” the psychiatrist added.

Heidel contended that social workers, family therapists and psychologists are not trained in providing patients with a thorough medical examination based on a history of illness. They are also not trained in monitoring patients’ side effects, he added.

Heidel pointed out that many psychiatric drugs have adverse side effects, such as increased appetite and weight gain, sexual dysfunction, tremors and headaches. Doctors need to educate patients on the risks, positive and negative effects of psychotropic drugs, so that patients aren’t discouraged and stop treatment within days.

He added, patients should be followed closely by a trained physician who can evaluate the correct dosage of treatments.

Dr. Ken Khoury, president of the San Diego Psychiatric Society, said he’s received various complaints from psychiatrists disapproving of Kaiser’s policy. He also said under the standard of practice, physicians cannot in good faith evaluate the mental health of an individual without having seen and examined a patient first-hand.

“There is no substitute for personal contact,” Khoury said.

Psychiatrists aren’t the only ones critical of Kaiser’s standard of care.

Russ Pierce, a clinical psychologist in Hillcrest, shared the opinion of the two interviewed psychiatrists.

“Decisions on psychotropic drugs should not be made based on a checklist,” Pierce said. Rather, Pierce added, they warrant face-to-face interaction.

“I would want to see the patient if only to have the direct conversation, not just a second-hand opinion. I think when a mental health professional evaluates someone, they don’t just do it on the basis of a checklist There can be visual issues of posture and things that go into the whole picture.”

He added, “We (psychologists) are not supposed to pass judgment on something that is out of our professional purview , and that is medication.”

Stewart of the Department of Corporations said it could take up to two months to evaluate the Kaiser case. The process may take longer.

Gov. Gray Davis signed legislation to shift the regulation of health plans from the Department of Corporations to the Department of Managed Care by July 1, she said.

The Department of Managed Care has yet to be created, she added.

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Health Care Cyberspace: San Diego-based Women First HealthCare, Inc., which markets health care products to women aged 35 to 69, recently said it struck two E-commerce deals with Women’s Consumer Network in Washington, D.C., an Internet firm that sells products exclusively for women.

Under the agreement, Women First will put health care content written by its own editorial staff on Women’s Consumer Network’s Web site at (www.womensconsumer.net).

In return, Women’s Consumer Network members will be able to access Women First’s online catalog (www.aswechange.com) free of charge for one year and buy products at a discounted price, Women First reported.

The catalog run by Women First’s As We Change unit sells pills, skin care, fitness equipment and other products to women age 40 and older.

Women’s Consumer Network is a private company that offers women information on finances, careers, families and everyday life experiences over the Internet for a membership fee.

“Their whole mission is to find products and services across the country that will save their members time and money,” said Nancy Casey, a spokeswoman for Women First.

Casey said the deal offers Women First access to Women Consumer Network’s vast membership, most of whom meet Women First’s target audience of women ages 40 and older.

The business model, Casey said, warrants business-to-business alignments over the Internet and tie-ins with firms that cater to women ages 40 and over.

Casey told the San Diego Business Journal on April 18 that Women First signed an agreement to link with two major ‘Net-based ventures , drugstore.com, an online pharmacy, and Amazon.com, the online bookstore.

Details of the agreement have not been determined.

Health care news can be sent to Marion Webb at mwebb@sdbj.com.

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