UCLA pays $10 million for retaliation against surgeon who exposed industry payments that may have compromised patient care

This case is just a small part of a larger problem at UCLA. Another small part of the problem, the behavior of Eugene Washington, dean of the David Geffen Medical School at UCLA, is discussed HERE.

UCLA'S $10 MILLION WHISTLE-BLOWER RETALIATION CASE:

"Shortly before Pedowitz joined UCLA in 2009, the university was already facing criticism from Congress over the failure of a top spine surgeon to report nearly $460,000 in payments he received from Medtronic and other medical companies while researching their products' use in patients, government records show.

"Dr. Jeffrey Wang, who left for USC Spine Center last fall, stepped down as head of UCLA's spine program in 2009 after U.S. Sen. Charles Grassley (R-Iowa) publicized his lapse in disclosure as part of a larger investigation into medical conflicts of interest.

"Several patients are now suing Wang and UCLA in state court for negligence, fraud and malpractice in connection with surgeries involving Medtronic's controversial Infuse bone graft."

"...'What good are all the policies if they protect the wrongdoers and fail to protect the actual whistleblower?' Quigley said. 'The university wanted to cover it all up.'"

UCLA surgeon Dr. Robert Pedowitz, who said the medical school allowed doctors to take industry payments that may have compromised patient care

UC OKs paying surgeon $10 million in whistleblower-retaliation case
The settlement ends a case brought by the ex-head of UCLA's orthopedic surgery department
By Chad Terhune
Los Angeles Times
April 22, 2014

University of California regents agreed to pay $10 million to the former chairman of UCLA's orthopedic surgery department, who had alleged that the well-known medical school allowed doctors to take industry payments that may have compromised patient care.

The settlement reached Tuesday in Los Angeles County Superior Court came just before closing arguments were due to begin in a whistleblower-retaliation case brought by Dr. Robert Pedowitz, 54, a surgeon who was recruited to UCLA in 2009 to run the orthopedic surgery department.

In 2012, the surgeon sued UCLA, the UC regents, fellow surgeons and senior university officials, alleging they failed to act on his complaints about widespread conflicts of interest and later retaliated against him for speaking up.

UCLA denied Pedowitz's allegations, and officials said they found no wrongdoing by faculty and no evidence that patient care was jeopardized. But the UC system paid him anyway, saying it wanted to avoid the "substantial expense and inconvenience" of further litigation.

[Maura Larkins: Closing arguments were about to begin in the case. UCLA had already invested "substantial expense and inconvenience", and would have incurred very little expense or inconvenience if it had simply allowed the closing arguments to go forward. The reason it settled was that it realized that the weight of the evidence showed that UCLA did indeed jeopardize patient safety and certainly violated conflict of interest standards and the legal rights of the whistle-blower.]

As department chairman, Pedowitz testified, he became concerned about colleagues who had financial ties to medical-device makers or other companies that could unduly influence their care of patients or taint important medical research.

He also alleged that UCLA looked the other way because the university stood to benefit financially from the success of medical products or drugs developed by its doctors.

One of the orthopedic surgeons that Pedowitz complained about testified at trial about receiving $250,000 in consulting fees in 2008 from device maker Medtronic. In memos to university officials, Pedowitz raised concerns about the financial dealings of other doctors as well.

Inside the courtroom Tuesday, Pedowitz sat in the front row with his wife and daughter as the judge told jurors that a settlement had been reached. He said he felt vindicated by the outcome.

"These are serious issues that patients should be worried about," Pedowitz said in an interview. "These problems exist in the broader medical system and they are not restricted to UCLA."

The seven-week trial in downtown Los Angeles offered a rare glimpse into those potential conflicts at a time when there is growing government scrutiny of industry payments to doctors.

Starting this fall, the federal Physician Payments Sunshine Act, part of President Obama's healthcare law, requires public disclosure of financial relationships between healthcare companies and physicians.

Many doctors and universities defend long-standing industry arrangements as essential for carrying out cutting-edge research and top-flight medical education.

In a statement Tuesday, the UC regents said they "resolved this lawsuit to end a prolonged conflict and permit UCLA Health Sciences to refocus on its primary missions of teaching, research, patient care and community engagement."

The statement added that "multiple investigations by university officials and independent investigators concluded that conduct by faculty members was lawful. Patient care was not compromised."

This latest settlement eclipses a $4.5-million payout the UC regents made last year to resolve a racial discrimination lawsuit filed by another UCLA surgeon.

Pedowitz, as part of his settlement, left the UCLA faculty, effective Tuesday. He had agreed to step down as department chairman in 2010 after initially voicing his concerns to top UCLA officials. He filed a whistleblower retaliation complaint in March 2011.

Experts in medical ethics say the UCLA case shows much more needs to be done within academia and by government regulators to address potential conflicts of interest in medicine.

Susan Chimonas, associate director of research at Columbia University's Center on Medicine as a Profession, said some medical schools are still reluctant to take on specialists who bring in considerable money from patients, medical research and patents on breakthrough products.

"Institutions can be dependent on the money these big-earning specialties like orthopedic surgery bring in," Chimonas said. "They are the cash cows and they can set their terms. This is not the first time I've heard of medical schools having policies that are not well enforced."

In an interview last week, the chief compliance officer at the UCLA Health System flatly rejected the notion that the university didn't enforce its policies or look fully into Pedowitz's allegations. She also said industry ties are unavoidable at a big medical school and rules are in place to prevent conflicts.

"We have processes in place to identify those relationships in a transparent fashion and ensure they don't have any inappropriate influence on the actions of the university," said Marti Arvin, chief compliance officer. "In order to meet our mission, it is important we have both the brilliant minds we have at UCLA and collaboration with industry."

Arvin said the university "thoroughly and objectively investigated those allegations of noncompliance raised by Dr. Pedowitz. We were able to determine the vast majority were unsubstantiated."

She said two doctors fell short of university expectations in their handling of outside income, but there was no violation of law or university policy in either instance.

Arvin cited the case of Dr. Nick Shamie, the orthopedic surgeon who testified at trial about receiving $250,000 from Medtronic for consulting work. She said department policy at the time didn't require Shamie to send that outside income through UCLA's faculty compensation plan.

At trial, Pedowitz said he was deeply troubled by the large amount of money Shamie was paid. He testified that he was particularly concerned that Shamie was trying to enroll patients in a research study involving Medtronic at the time.

"I saw this as an obvious problem," Pedowitz testified.

In court, Shamie said he abided by university policy and didn't pursue the study further because finding patients was too difficult. He couldn't be reached for additional comment.

The other physician cited by Arvin for a potential shortcoming was Dr. David McAllister, vice chairman of clinical operations for the orthopedic surgery department.

He didn't report payments from the Musculoskeletal Transplant Foundation, a nonprofit tissue bank that does business with UCLA, because he didn't think disclosure was required in that instance because it didn't involve a for-profit entity, Arvin said.

McAllister also declined to comment, referring a call to UCLA.

Shortly before Pedowitz joined UCLA in 2009, the university was already facing criticism from Congress over the failure of a top spine surgeon to report nearly $460,000 in payments he received from Medtronic and other medical companies while researching their products' use in patients, government records show.

Dr. Jeffrey Wang, who left for USC Spine Center last fall, stepped down as head of UCLA's spine program in 2009 after U.S. Sen. Charles Grassley (R-Iowa) publicized his lapse in disclosure as part of a larger investigation into medical conflicts of interest.

Several patients are now suing Wang and UCLA in state court for negligence, fraud and malpractice in connection with surgeries involving Medtronic's controversial Infuse bone graft. UCLA said it doesn't comment on pending litigation. Wang couldn't be reached for comment.

Shortly after raising his concerns, Pedowitz said, he was pressured to step down as department chairman in 2010. Pedowitz said he was further retaliated against by being denied patient referrals and prevented from participating in grants and other activities.

Before UCLA, Pedowitz worked at UC San Diego and as chairman of orthopedics and sports medicine at the University of South Florida.

Mark Quigley, an attorney representing Pedowitz, said the case could have been avoided if the UC system enforced the policies it already has in place.

"What good are all the policies if they protect the wrongdoers and fail to protect the actual whistleblower?" Quigley said. "The university wanted to cover it all up."

Cheryl Clark seems to be working for a magazine, Health Leaders, that is genuinely interested in improving the practice of medicine

Cheryl Clark seems to be working for a magazine, Health Leaders, that is genuinely interested in improving the practice of medicine.

Cheryl Clark
Health Leaders
Nov. 2, 2013

Are you a journalist interested in how doctors practice medicine?

A position is opening up at the company I work for that I would seriously consider applying for. You'd write for hospital providers and physicians about issues in service lines, ethics, physician culture and behavior, relationships with hospital administrators, care appropriateness, medical training and certification, fraud, regulatory changes that are pivoting doctor pay toward outcomes measurement for the whole patient and away from the "pay per visit" and lots of other stuff.

You'd write 50 weekly columns a year and 1,700 (or so) -word articles for our monthly print magazine, HealthLeaders.

Samuel Shem: What I've learned from speaking out against the brutality of medical training

Samuel Shem, 34 Years After 'The House of God'
What I've learned from speaking out against the brutality of medical training, in advocacy of quality connection -- and four additional "laws" for good doctors
By Samuel Shem
The Atlantic
Nov 28 2012

For better or worse, except in real danger, I don't seem to run on fear. Guilt, yes; fear, no.

It's a good thing, because my book The House of God enraged many among the older generation of doctors. I was maligned and disliked. The book was censored by medical school deans, who often kept me from speaking at their schools. None of it really bothered me, though. I was secure in the understanding that all I had done was tell the truth about medical training.

I took this pseudonym because I was just starting my psychiatric practice and wanted to protect my patients from knowing that their therapist had written such an irreverent novel. (They all found out, and didn't care -- but "Shem" had arrived, and refused to depart.) I also felt that real writers had no place in going out and publicizing their novels. I refused all invitations. And then one day I got a letter forwarded from my publisher, which included the line:

"I'm on call in a V.A. Hospital in Tulsa, and if weren't for your book I'd kill myself."

I realized that I could be helpful to doctors who were going through the brutality of training. And so I began what has turned out to be a 35-year odyssey of speaking out, around the world, about resisting the inhumanity of medical training. The title of my talk is almost always the same: "Staying Human in Health Care."

The theme of my speaking out is simple: the danger of isolation, the healing power of good connection. And any good connection is mutual.

I base a lot of my talks on what I've learned from The House of God. About how I've come to see it, and all my novels, as a "fiction of resistance," a way of resisting the injustices of a system.

It wasn't until years into my journey that I realized the importance of the fact that I and my fellow interns were products of the 1960s. We grew up in that unique lost period of American history -- beginning with FDR and ending with Reagan -- when we learned that if we saw an injustice, and got together and took action, we could bring about change. During my college years, we helped put the Civil Rights laws on the books and ended the Vietnam War. When we entered our internships we were a generation idealistic young docs. We soon were caught in the clash between the received wisdom of the medical system, and the call of the human heart. Our patients, and we, were being treated inhumanely. As Chuck the intern put it:

"How can we care for our patients, man, if nobody cares for us?"

If we decide to walk through suffering alone -- "stand tall, draw a line in the sand, tough it out" -- we will suffer more, and spread more suffering around.

And so we took action. The novel can be read as a model of nonviolent resistance. Big hospitals, like all large hierarchies, are "power-over" systems. The pressure comes down on the ones at the bottom, and they become isolated. Not only do they get isolated from each other, but each gets isolated from his or her authentic experience of the system itself. You start to think "I'm crazy," instead of "This is crazy." In The House one of the interns does go crazy, and another commits suicide.

The crucial question is how to find mutuality -- or "power-with" -- in a "power-over" system. Historically, the only threat to the dominant group -- whether of race, gender, class, sexual preference, ethnicity -- is the quality of the connection among the subordinate group.

***

In The House of God there were 13 "Laws." I would now add these four:

Law 14 : Connection comes first. This applies not only in medicine, but in any of your significant relationships. If you are connected, you can talk about anything, and deal with anything; if you're not connected, you can't talk about anything, or deal with anything. Isolation is deadly, connection heals.

One of the worries in how the new generation of doctors practice medicine is their use of computers. If you have a laptop or smart phone between you and your patient, you are much less likely to create a good, mutual connection. You will miss the subtle signs of the history, of the person. With a screen between you, there is no chance for mutuality, and the connection has qualities of distance, coolness, rank, authority, and even disinterest. The "smart" digital appendages can make you, in human-connection terms, a "dumb" doctor.

This, as more and more studies suggest, can lead -- hand in hand with the tyranny of algorithms and other "quality/efficiency/cost-containers" -- to more tests, more errors and medical mistakes, lower quality care, and higher costs to all.

Law 15 : Learn empathy. Put yourself in the other person's shoes, feelingly. When you find someone who shows empathy, follow, watch, and learn.

Law 16 : Speak up. If you see a wrong in the medical system, speak out and up. It is not only important to call attention the wrongs in the system, it is essential for your survival as a human being.

Law 17 : Learn your trade, in the world. Your patient is never only the patient, but the family, friends, community, history, the climate, where the water comes from and where the garbage goes. Your patient is the world.

Some have said that The House of God is cynical. And yet in rereading, it has a constant message that I was dimly conscious of in writing: being with the patient. In the words of the hero of the novel, the Fat Man, "I make them feel that they're still part of life, part of some grand nutty scheme, instead of alone with their diseases. With me, they still feel part of the human race." And as the narrator Roy Basch realized, "What these patients wanted was what anyone wanted: the hand in their hand, the sense that their doctor could care."

And so in 1974 I came away from The House of God aware of at least one thing: The essence of medical care, and life, is connection.

***

Fast forward 30 years.

I have published two more novels -- Fine and Mount Misery. Also, with my wife, co-wrote the play Bill W and Dr. Bob about the founding of Alcoholics Anonymous, and a nonfiction book We Have to Talk: Healing Dialogues Between Women and Men.

Love and death. How lucky we are.

During this time, as they say, life happened. There were many life struggles, and walks through the suffering. Luckily, at the right times, I was accompanied by others.

From Mount Misery, and also from conducting gender dialogues all over the world while writing We Have to Talk, I learned the importance of shifting focus from a center on "I" or "You", to "We." As in, for physicians, "We've got all the information; let's talk about what we can." The patient will say, "I think maybe we should .. " Suddenly there is a concreteness in your approach to treatment, that you are in this together.

From Bill W. and Dr. Bob, I learned that, in Bill's words: "The only thing that can keep a drunk sober is telling his story to another drunk." Alone, an alcoholic cannot resist alcohol. The self alone -- self-will or self-discipline -- will not work. What works is asking for help from a non-self-centered perspective. AA is an astonishing mutual-help organization, because alcohol and drugs are diseases of isolation.

***

My latest novel, The Spirit of the Place, took me in a new direction. I had always wanted to go back to my small town on the Hudson River and join my old mentor, a family doctor, in practice. Life had taken me elsewhere, but the beauty of fiction is that you can do in a novel what you haven't in the world.

At a point toward the end of the novel, the fraught protagonist has to make a choice. He struggles with it until he hears a kind of voice in his head:

"Don't spread more suffering around. Whatever you do, don't spread more suffering around." ...

--Samuel Shem, MD, PhD, is a doctor, novelist, and playwright. He is the author of books including The House of God and The Spirit of the Place.

Many "mistakes" found in newbie-doctors' resumes

Many "mistakes" found in newbie-doctors' resumes
By Kerry Grens
Feb 21, 2012
(Reuters Health)

Honesty and attention to detail are qualities expected of physicians, yet two studies looking at applications to training programs in obstetrics show that up to 30 out of every 100 applicants took credit for research publications that could not be found.

"Our hope is that these are honest mistakes and not willful attempts to mislead," said Dr. Michael Frumovitz, a professor at the University of Texas MD Anderson Cancer Center in Houston, and lead author of one of the studies.

In a field where precision is important, "even if it's an honest mistake it's very troubling," he said.

Earlier studies have found that other specialties within medicine suffer from the same problem.

Anywhere from one to 30 percent of applications to training programs in radiology, emergency medicine, orthopedics and others include references to published research that can't be located by reviewers.

Frumovitz and his colleagues and a separate group at the University of Washington, who published their reports in Obstetrics & Gynecology, wanted to find out if the same was true in their fields.

The team led by Frumovitz collected all 258 applications to a fellowship program at MD Anderson in gynecologic oncology from 2004 to 2008.

The applicants were doctors who had completed their medical school and residency training.

Of the 148 doctors who listed that they had published research findings, 44 included a reference to a publication that Frumovitz's group could not track down.

"We all believe that applicants have the best intention and are representing themselves truthfully. But (this result) falls right in line with others who have done similar work," said Frumovitz.

The University of Washington team, led by Dr. Anne-Marie Amies Oelschlager, looked through two years' worth of applications to a residency program in obstetrics and gynecology.

Residents are doctors who have finished medical school, and are continuing their required clinical training in a particular field.

Among the 937 applicants, 357 put down that they had at least one research study that was published or about to be published in a peer-reviewed outlet.

When Amies Oelschlager's group went to find those publications, 156 of the 1,000 publications listed turned up missing.

They looked online, in publication databases and even contacted the journal for verification.

Of the other publications that were confirmed, the researchers found inaccuracies there as well.

The biggest error was that 62 applicants had listed a publication as "peer-reviewed" when it wasn't.

Peer review involves submitting a study for scrutiny by other researchers before it gets published, and therefore implies a high degree of rigor.

Amies Oelschlager said her study could not tell whether these were honest mistakes or intentional misrepresentations.

"The best you can assume is that these applicants didn't look up what peer review meant or they don't understand it," she told Reuters Health. "None of that is flattering and you worry whether they really understand the tenets of authorship, research, what is peer review and what is not."

Residencies and fellowships are competitive, and research experience is looked upon favorably when applicants are being reviewed.

"Applicants might be deliberately padding their resumes to try and get a spot, and it's concerning. The whole thing about being a physician is that you are expected to be honest," Amies Oelschlager said.

Dr. Lee Learman, a professor of obstetrics and gynecology at Indiana University School of Medicine, said that it's not clear whether errors on applications relate to errors in medical practice, but it is of concern.

He said that medical students and residents should be aware that misrepresenting their work could have negative consequences on their careers.

"Even though we don't know how this predicts future infractions, most directors of residencies and fellowships don't want to take the risk," Learman told Reuters Health. "They might say, this person might misrepresent data about a patient or misrepresent a step they took during surgery."

Learman encouraged directors of residency and fellowship programs to check the accuracy of applications, and if they can't find the publications listed, to ask the person to produce a copy.

Frumovitz said one way to make sure publication lists are accurate is to require that applicants include a copy of the paper or an identification number that will make it easier to look up.

Amies Oelschlager and her colleagues suggested that medical schools should include training in authorship and peer review.

Chief at Kaiser: doctors aware when hired that they would be required to violate professional standards

Dennis Cook, M.D., coordinating chief of psychiatrists for Kaiser’s Southern California division, is quoted by the Times as saying that Jensen was well aware of the policy when he was hired.


Kaiser's Prescribing Policy Leads To Lawsuit, Ethics Concerns
Psychiatric News
May 5, 2000

One of the nation’s best-known HMOs has ignited a furor by requiring psychiatrists at one of its California facilities to write prescriptions for patients they have never seen.

Kaiser Permanente’s policy for psychiatrists in its San Diego area facilities stipulates that when they receive a request for a prescription for a patient that a staff psychologist, social worker, or family therapist is seeing, they are to comply with the request and write the prescription without scheduling a visit with the patient.

Widespread publicity about the policy, which was the focus of an April 13 Los Angeles Times article, has generated heated responses from psychiatrists and others concerned about how such a policy could seriously compromise patient care and put psychiatrists in ethical jeopardy.

The article revealed that a state agency was investigating this practice and that a psychiatrist who lost his job after refusing to follow the policy was suing Kaiser Permanente.

The day after the article appeared, APA issued a press release strongly condemning the policy as an example of "unethical" medical practice.

In that statement APA President-elect Daniel Borenstein, M.D., a private practitioner in Los Angeles, said it is "unethical and substandard practice for a psychiatrist to prescribe medication for a patient without personally examining that patient and determining the necessity for medication."

He emphasized that Kaiser Permanente’s practice "trivializes mental illness and the special medical skills of psychiatrists in diagnosing and treating it."

APA’s press release cites two paragraphs of its ethics code that may be violated by Kaiser’s prescribing policy. One states, "When the psychiatrist assumes a collaborative or supervisory role with another mental health worker, he/she must expend sufficient time to assure that proper care is given. It is contrary to the interests of the patient and to patient care if he/she allows himself/herself to be used as a figurehead."

Another relevant paragraph says that in relationships between psychiatrists and psychologists, "The physician should not delegate to the psychologist or, in fact, to any nonmedical person, any matter requiring the exercise of professional medical judgment."

Psychiatrist Fired

The San Diego psychiatrist who filed suit against Kaiser, Thomas Jensen, M.D., wants the court to step in and order the HMO to stop the practice, which he contends violates state law about prescribing and dispensing drugs. Kaiser fired Jensen in December after he refused to prescribe medications for HMO patients he had never seen.

Dennis Cook, M.D., coordinating chief of psychiatrists for Kaiser’s Southern California division, is quoted by the Times as saying that Jensen was well aware of the policy when he was hired. In his suit, Jensen said that on his first day on the job, he received medication requests from social workers, social work interns, and marriage and family therapists.

"I was astounded that this was happening," Jensen said. "I was trained that you don’t prescribe medicines for patients you’ve never seen." He said he had seen drug recommendations from nonphysicians that if prescribed would have jeopardized patients’ health.

Oliver Goldsmith, M.D., medical director and chair of the board of Southern California Permanente Medical Group, said in an April 20 press release that contrary to reports, Kaiser does not have an official policy of requiring psychiatrists to prescribe without seeing the patient. He said psychiatrists in the medical group developed a "multidisciplinay team-based approach" in which "psychiatrists in San Diego work very closely on a regular basis with other mental health professionals in a group practice. It is a physician-designed and physician-driven approach in which physicians exercise their medical judgment and authority in rendering care."

Joel Hyatt, M.D., assistant associate medical director for the Southern California Permanente Medical Group, said that "all decisions to examine the patient or to prescribe medication are made by physicians."

In defending the policy, Cook stated that he believes "it’s very ethical." He noted that all of its psychiatrists are informed of and agree to the prescription policy before they are hired. He explained that Kaiser psychiatrists can refuse to follow through on a prescription request from a nonphysician therapist if they believe that medication is not appropriate for a particular patient. If medication is likely to benefit the patient, however, they are obligated to prescribe one.

While psychiatrists may be well informed about the policy, as Cook said, there is a serious question about how well informed patients are.

Sam Muszynski, director of the APA Office of Healthcare Systems and Financing, raised the issue of whether patients are getting any meaningful informed consent when their medication information comes from nonphysicians. "It is hard to believe," he said, that psychologists, social workers, and other therapists can describe the wide range of side effects for which patients need to be alert or can diagnose symptoms that may be the result of interactions with other drugs with anywhere near the degree of competency that a physician can provide.

Kaiser did acknowledge after the suit was filed that it is aware that its prescribing standards differ from those used by other treatment facilities in the region. Cook told the Times that the policy allows psychiatrists to see more patients by eliminating the need for them to conduct duplicate interviews for patients who have already been assessed by a nonphysician therapist. He also called the attacks "self-serving" since, he said, they come from private practitioners who stand to gain from additional office visits if Kaiser is forced to alter its policy.

Comments About Policy

The president of the San Diego Psychiatric Society (SDPS), Kenneth Khoury, M.D., does not see any benefit for patients or physicians in the policy. The policy clearly fails to meet the standard of care in the community, he told Psychiatric News, and "exceeds the boundaries" of what goes into providing "quality care and safe care." There is no room for negotiation on this issue, he noted. He said that the district branch has asked the Medical Board of California to clarify its understanding "that the standards of care and state law say that physicians must conduct face-to-face interviews" with patients before they write prescriptions for them.

Khoury has also asked Michael Newhouse, M.D., chair of the SDPS Ethics Committee, to "review the concerns" raised about possible ethical violations and report his findings to the SDPS Council. He said that 15 San Diego psychiatrists work for that area’s Kaiser Permanente group, of whom three are members of the district branch.

Yvonne Ferguson, M.D., president of the California Psychiatric Association (CPA), said she was "shocked to learn that Kaiser, which enjoys a good reputation in California, had such a policy." She suggested that the controversy "will bring the whole scope-of-practice issue into bold relief," adding that psychiatrists "cannot shrink from confronting this issue. Also, legislators will have to look at [scope of practice], and the public will have to be educated about implications of Kaiser’s policy."

The suit also charges Kaiser and the Southern California Permanente Medical Group with violating consumer protection laws by engaging in deceptive advertising, such as touting that at its HMOs "physicians alone manage all aspects of care" and that "medical decisions are made by physicians in consultation with their patients, not by health plan administrators. . .no third party comes between medical decisions."

Jensen, who moved from Maine to work for Kaiser, now teaches part time in the psychiatry department at the University of California at San Diego. Explaining why he chose to go the legal route, he commented, "As a physician I was required not only to refuse to [prescribe without seeing the patients], but to do what I could to end the practice because it endangered patients."

Kaiser is the nation’s largest not-for-profit HMO and has 8 million subscribers.—K.H.

[Thomas S. Jensen, M.D., v. Kaiser Foundation Health Plan, et al.; case no. 825090-6]




October 6, 2000http://www.blogger.com/img/blank.gif
San Diego Psychiatrist Settles Lawsuit With Kaiser
Psychiatric News

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...

[Maura Larkins' comment: It appears that part of the settlement, which was probably very lucrative for Jensen, involved a requirement that Jensen say nice things about Kaiser. Sorry, Dr. Jensen. Anything you say after being paid must be taken with a grain of salt.]

Do we need more ethics screening for medical students and doctors?

Apparently this medical student was not motivated by the desire to help his fellow humans be healthier. I wonder how many doctors are motivated by the desire to help others?



Suspect in Craigslist slaying indicted
June 21, 2009
CNN

A Massachusetts grand jury late last week indicted a 23-year-old medical student on seven counts, including first-degree murder, in the fatal shooting of one woman and the robbery of another in Boston hotels.
Philip Markoff is charged with killing a woman and robbing another in Boston hotels in April.

Philip Markoff is charged with killing a woman and robbing another in Boston hotels in April.

Philip Markoff is charged with the April 14 fatal shooting and attempted robbery of Julissa Brisman, 25, and the armed robbery of a 29-year-old Las Vegas woman on April 10. Investigators have linked both incidents to advertisements on the Craigslist classified ad Web site.

Markoff also is charged with "the armed and forcible confinement" of the two women, as well as two counts of unlawful firearm possession, the Suffolk County District Attorney's Office said Sunday.

The grand jury returned the seven-count indictment late Thursday, and it moves the case from Boston Municipal Court to Suffolk Superior Court, where Markoff is expected to appear for a Monday morning arraignment. He previously pleaded not guilty in the city court and is being held without bail.

Markoff's attorney, John Salzberg, had no comment on the new indictment.

Prosecutors said Brisman, a model from New York who advertised as a masseuse on Craigslist, was shot three times at close range and suffered blunt head trauma at the Marriott Copley Place hotel.

The Las Vegas woman was robbed of $800 in cash and $250 in American Express gift cards at the Westin Copley Place hotel, police reports said.

Markoff, a second-year medical student at Boston University's School of Medicine, also has been charged in a nonfatal hotel assault in Rhode Island.

He has been charged with assault with the intent to rob, assault with a dangerous weapon, possession of a handgun and use of a firearm while committing a crime of violence, stemming from an April 16 robbery attempt at a Holiday Inn Express in Warwick, Rhode Island.

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Advisory Board

Code of Ethics
In the conduct of our business, we are and will continue to be guided by the following principles:

We will be fair and truthful in our relations with our clients, our coworkers and our carriers.

We will conduct our business in a manner which will enable us to take pride in our efforts and in the products and services that we provide.

We will be flexible and responsive to the changing world in which we live.

We will constantly strive to improve upon all we do.

We will act in a manner that will earn the respect and esteem of others.

We will be exemplary citizens in the communities in which we live.

We will achieve all financial success and growth as a result of adhering to these principles.

Community Involvement

Keenan is dedicated to making a difference in the lives of those less fortunate. At Keenan, we seek out opportunities to give to those communities where the company has business and employee presence.

Corporate Giving - Contributing to the creation of a stronger and better community is the responsibility of every corporation. Keenan strives to make a difference in its community through donations, sponsorships and employee volunteerism.

Community Enrichment - Keenan fosters personal growth in the lives of individuals and groups through its participation in education, arts and cultural programs.

Outreach - Keenan employees have an opportunity to directly impact their community by giving of their time, talents and resources.


http://www.keenan.com/news/presskit_coe.asp

Keenan code of ethics

Code of Ethics

In the conduct of our business, we are and will continue to be guided by the following principles:

We will be fair and truthful in our relations with our clients, our coworkers and our carriers.

We will conduct our business in a manner which will enable us to take pride in our efforts and in the products and services that we provide. [What exactly makes these people proud? To make a lot of money?]


We will be flexible and responsive to the changing world in which we live.

We will constantly strive to improve upon all we do.

We will act in a manner that will earn the respect and esteem of others. [Which others? The ones who think obtaining money and power deserves respect, even if you have to violate the law to do it?]

We will be exemplary citizens in the communities in which we live. [Money, again. Keenan will appear to act in the public interest on some occasions if it gets a good photo opportunity and the chance to impress customers.]

We will achieve all financial success and growth as a result of adhering to these principles. [So far, so good.]

http://www.keenanpa.com/expert-code.asp