October 6, 2000

legal news

San Diego Psychiatrist Settles Lawsuit With Kaiser

Psychiatrist Thomas Jensen, M.D., agrees to a settlement of his lawsuit against Kaiser, his former employer. The suit stemmed from the HMO's policy of compelling its psychiatrists to prescribe drugs for patients they had not evaluated.

By Ken Hausman

A San Diego psychiatrist who ignited a furor earlier this year when he blew the whistle on the questionable prescribing policies of Califor-nia’s largest HMO has settled his lawsuit against that organization.

Soon after he was hired by Kaiser Permanente’s San Diego HMO, Thomas Jensen, M.D., protested his employer’s policy of requiring psychiatrists to prescribe medications for patients they had never evaluated on the recommendation of psychologists, social workers, or marriage and family counselors (Psychiatric News, May 5, May 19).

Jensen maintained that Kaiser’s prescribing policy violated state law governing how medications can be prescribed and dispensed. He said as well that he had seen medication requests from nonphysician therapists that could have harmed patients’ health if a psychiatrist had complied with the prescribing recommendation. Moreover, he and other California psychiatrists questioned whether complying with the prescribing policy was in fact a breach of medical ethics, and APA issued a press release condemning it as just such a violation.

Last December, Jensen maintained, Kaiser, the nation’s largest not-for-profit HMO organization, responded to Jensen’s airing of the policy by firing him.

After his firing, Jensen filed suit against Kaiser and asked the court to order the organization to halt its prescription policy. Kaiser officials defended the policy, explaining that it was based on a "multidisciplinary team-based approach" developed by psychiatrists at the HMO. At the time Jensen filed his suit, Kaiser employed 22 psychiatrists at its San Diego HMO.

Kaiser Retracts Policy

In early May, several weeks after the prescribing policy and the subsequent lawsuit were described in a Los Angeles Times article—and amid considerable fingerpointing about who developed and knew about the policy—officials of Southern California Permanente Medical Group (SCPMG), which owns the San Diego HMO, announced that the organization was going to change its prescription policy to require that all new psychiatry patients will have "to be examined by a physician before medication is prescribed."

While he was pleased about its reversal on the psychiatrist prescribing requirement, Jensen vowed to proceed with his lawsuit against Kaiser, saying he was unwilling to drop it based on the promise contained in a press release to retract its policy.

Now that his suit has been settled, Jensen said he is "very proud of what it accomplished because some good things came out of it." While the settlement agreement prohibits him from revealing some of its terms, such as any financial compensation he received, Jensen told Psychiatric News that the SCPMG did agree to implement a new written policy for handling psychiatric medication prescriptions and evaluating patients who may need them.

In addition, Kaiser Hospitals, which contracts with the SCPMG to provide medical services to Kaiser beneficiaries, apologized for firing him after he complained about the policy and for the impact the firing had on his and his wife’s life, Jensen said. Kaiser also offered to reinstate him at the San Diego HMO, but he noted that "after all that has happened, it does not seem to be a good idea for me or [the company] that I return."

Jensen Reacts

Despite the turmoil it caused him, Jensen did have some good words for Kaiser Hospitals. "Once it got to their level, they did everything necessary to straighten out the issues regarding psychiatric medications and evaluations," he said.

He also cited "other good things" that resulted from his lawsuit, including an article in the California Medical Board’s quarterly journal titled "What to Do When a Nonphysician Asks You to Prescribe," which "clarifies what a good-faith examination actually requires," Jensen noted. "It sent an extremely clear message that this kind of [prescribing] practice is not acceptable."

Further, he strongly believes that all the publicity that swirled around his suit and the SCPMG’s prescribing policy "will act as a deterrent and in the future make physicians less reluctant to go along" with a policy they know is unethical and potentially harms patients.

In fact, ethics charges have been filed with the San Diego Psychiatric Society in conjunction with the Kaiser prescription policy, but SDPS President Timothy Murphy, M.D., noted in an interview with Psychiatric News that the strict confidentiality of ethics proceedings prohibited him from discussing any details.

Kaiser Permanente issued a statement following the settlement saying, "We believe we responded appropriately and thoughtfully and effectively to the issues that were raised by Dr. Jensen, and we wish him well on his future endeavors." Kaiser spokesperson Jim Anderson told Psychiatric News that the organization would have no further comment on the episode.

Jensen expressed his gratitude to several organizations that supported his action, including his district branch, the SDPS. The district branch "didn’t hesitate to get involved despite the possibility that it could divide the psychiatric community in town," he emphasized. He also cited APA for moving "at lightning speed" to issue a strong public statement condemning the HMO’s prescribing practice and explaining why it is detrimental to patient care. He said he appreciated that the California Medical Board and the California Board of Corporations "took the issue seriously" and immediately agreed to investigate the matter. "It’s nice to see public regulatory agencies jump on an issue like this," Jensen said. Both the medical board and the California Department of Managed Care (which is a new agency that inherited the Board of Corporation’s health-related responsibilities) are continuing to investigate complaints about Kaiser’s prescribing practices.

"Being a whistle-blower turns out to be an extremely stressful experience even when it goes well," he stressed. "Knowing that I was not standing alone made a big difference."

And perhaps surprisingly, he said that despite all the personal and professional upheaval he endured, he had no regrets. "Given the choice of going through an ordeal like this or walking away from ethical and legal violations, I would choose to pursue the same course all over again—but I hope I never have to."