KAISER PERMANENTE I: Insurer Drops Controversial Rx Writing Rule

      Kaiser Permanente yesterday announced it will abandon a controversial policy that requires its psychiatrists to prescribe drugs to patients they have not personally examined. The policy, which Kaiser officials say was contained within clinics in the San Diego area, drew criticism from health care advocates, who charged that it "endangered mental health patients and violated ethics codes." The policy also sparked an investigation by state regulators. Under the new rules, Kaiser psychiatrists must first examine a patient before writing prescriptions, rather than relying on recommendations from social workers, family therapists and social work interns. Kaiser executives had maintained that the policy allowing psychiatrists to give prescriptions on the basis of observations by nonmedical personnel "allowed physicians to see more patients by eliminating a potentially redundant initial interview." However, Dr. Thomas Jensen filed a lawsuit against Kaiser after he was fired for refusing to abide by the policy. The suit brought national attention to the practice, and public outcry prompted the HMO to review the rule (Maharaj, Los Angeles Times, 5/3). Dr. Oliver Goldsmith, medical director and chair of the Southern California Permanente Medical Group (SCPMG), said, "Naturally, we felt it was important to address thoughtfully the criticism of the San Diego practice. We believe that changing our prescribing practice in San Diego will make it consistent with SCPMG practices in the rest of Southern California and will be responsive to the concerns that were raised."

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      Jensen said he was pleased with the decision, but noted that questions still remain. "Does that mean the patient will get an appropriate evaluation by a doctor before they prescribe medications or simply that a doctor will briefly say hello to them?" he asked, adding that Kaiser also needs to guarantee appropriate follow-up care (Fong, San Diego Union-Tribune, 5/3). Jensen's attorney, Cliff Palefsky, said his client will not drop the lawsuit "until he sees changes that are 'real and complete.'" He explained, "We obviously need to wait and understand whether the changes will result in improved quality of care for patients." Daniel Borenstein of the American Psychiatric Association called the change "phenomenal," adding, "It goes along with our code of ethics and what we consider to be appropriate practice." Despite the change, a spokesperson for the state Department of Corporations said the agency will continue its investigation into the HMO and several allegations that patients received prescriptions for drugs that were inappropriate or harmful (Los Angeles Times, 5/3).