Philanthropist’s death sparks lawsuit against UCLA psychiatrist who was treating her

Philanthropist’s death sparks lawsuit against UCLA psychiatrist who was treating her
By Associated Press
August 4, 2012

Philanthropist's Death Sparks Unusual Lawsuit
By LINDA DEUTSCH
August 4, 2012 (AP)

When former model and philanthropist Phyllis Harvey died last year at the age of 59, little note was taken. Brief paid obituaries appeared in Los Angeles and her hometown paper in North Carolina.

There was no mention of how she died. Nothing was said about her struggle with alcoholism and mental illness. And there was no reference to one of the final projects she helped fund with nearly a half million dollars.

Those details now figure prominently in a medical board complaint and wrongful death lawsuit claiming her psychiatrist coaxed $490,000 in research funding from her while she was under powerful doses of psychotropic drugs that eventually killed her.

The suit filed on behalf of Brian Harvey by attorney Daniel M. Hodes accuses University of California, Los Angeles psychiatrist Dr. Alexander Bystritsky of causing Phyllis Harvey's death with a dangerous combination of drugs that altered her heart rhythm.

Hodes says that Mrs. Harvey was hospitalized several times for heart abnormalities associated with drugs, and that emergency room doctors discontinued her medications only to have Bystritsky resume giving them to her when she was discharged.

Brian Harvey earned a fortune by selling an invention for coating electronic wires with recycled metal from beer cans. Following the sale of his company, he and his wife formed the Brian and Phyllis Harvey foundation to fund scholarships and other donations. The lawsuit claims Bystritsky knew of the couple's wealth and charitable giving and insinuated himself into their lives with house calls, long chats and email with Phyllis Harvey while treating her undiagnosed mental illness. He allegedly touted his own credentials and convinced her to give large donations to research a device that might cure her.

The claim that a physician solicited research funds from a patient provides a new wrinkle in the debate over the relationship between doctors, wealthy patients and the overuse of prescription drugs.

"Was he continuing to treat her with these high-powered drugs to keep her as a patient?" said James J. Walter, a professor at the Center on Bioethics at Loyola Law School. "Every bioethicist would say that practice should be discouraged."

The lawsuit filed in Los Angeles County Superior Court claims wrongful death due to medical negligence, fraud, fraudulent concealment and intentional infliction of emotional distress.

Numerous phone messages left for Bystritsky and his lawyer by The Associated Press were not returned.

The suit also names the UC Board of Regents as defendants, noting that they sent glowing letters of thanks to the Harveys for their donations.

A spokeswoman for UCLA said she could not discuss medical specifics because of privacy concerns but said UCLA will contest the lawsuit.

"The UCLA health care system is committed to the highest standards of patient care and safety," said spokeswoman Roxanne Moster. "This is a regrettable and unfortunate case for everyone involved and we extend our deepest sympathies to members of the Harvey family for their loss."

Bystritsky began treating Harvey in 2004, five years after she was diagnosed as possibly suffering from bipolar disorder, early dementia or schizophrenia, according to documents in the case.

None of those diagnoses was ever fully confirmed by tests and Bystritsky soon had her on a regimen of several psychotropic drugs including Seroquel, a powerful anti-psychotic, said John Harwell, a lawyer who filed a complaint with the Medical Board of California last November on behalf of Brian Harvey.

The lawyers contend that drug, which is known to alter heart rhythm, killed her when she died in her bed April 5, 2011.

"Mrs. Harvey died from sudden cardiac death," Harwell told the medical board, "the very kind of consequence warned against by the FDA in its required Black Box Seroquel warnings, the ones Dr. Bystritsky either ignored or of which he was ignorant."

The medical board declined to comment on whether a complaint is pending before it.

Harvey had overcome alcoholism when she was younger, but she relapsed after her mother's death in 2009, Harwell said. During one of several hospital admissions, she told a doctor she was drinking a bottle of liquor a day along with the sedative Ativan, a potentially lethal combination.

In the two months before her death, the lawyers said she was receiving nine different drugs including benzodiazepine sedatives, Invega, a drug for schizophrenia, and Seroquel which was prescribed by Bystritsky at 180 tablets in 17 days.

Heavy doses of drugs in large volumes led to hospitalizations for overdoses of benzodiazepines, leading to falls, disorientation and intoxication, Harwell said. Emergency room doctors discontinued her medications, but Bystritsky resumed giving them when she was discharged. At times, he said, she became delirious and had hallucinations that bugs were crawling on her skin.

The lawsuit claims that the psychiatrist told Harvey he might be able to cure her with a device he invented, but that he said he needed more money to continue research on the machine.

An Internet search shows that Bysrtritsky, who heads the anxiety disorders program at UCLA, was a partner in a privately held company called Brainsonix which is collaborating with UCLA and Harvard Medical School on an ultrasound device to modulate brain function and treat brain disorders including depression, autism, Parkinson's Disease, epilepsy, obesity and other ailments.

His list of credentials shows that he was trained in neuroscience, psychopharmacology and psychiatry at Pavlov Medical Institute in Russia, New York University and UCLA. He also is a visiting full professor at Harvard University School of Medicine.

Harvey declined to seek criminal charges against Bystritsky because that might have required proving he intended to harm his patient, attorney Hodes said.

Experts said the case would be divided into two issues — the standard of care provided and ethical considerations involved in soliciting donations from a patient.

If true, "It would be a horrible indictment of the fund raising efforts of UCLA," said Donna Darling, a former New York assistant district attorney who now represents plaintiffs in medical malpractice suits. "They should have known she was a patient."

Attorney Harland Braun, who has represented doctors in malpractice cases, said Bystritsky may raise a strong defense that he was trying to help a gravely ill patient and had no intent to harm her. The fact that money was donated to his research, he said, suggests no desire for personal enrichment.

"Jurors have a tendency to trust doctors," said Braun, "and If you can't show the doctor had a motive to do harm, jurors will side with him."

San Diego Kaiser Permanente doctor turns in medical license for reportedly viewing child porn at work

Doctor turns in medical license for reportedly viewing child porn at work
Dave Thomas
San Diego News Examiner
December 22, 2011

An area doctor was prohibited from practicing medicine after he was reportedly nabbed viewing child porn in his El Cajon practice.

According to a 10News report, Dr. Mark Zweifach had to turn in his medical license earlier this month as a result of being caught looking at images of child porn while at work. Reports say Zweifach has been practicing medicine since 1982.

The California Medical Board records noted:

"In about July, August, and September 2007, Respondent, a physician with Kaiser Permanente in San Diego, California, used his Kaiser Permanente assigned computer in his office in the Kaiser Permanente Bostonia Medical Office Building, located in El Cajon, California, to access suspected child pornography websites on the internet. When confronted by Kaiser Permanente investigators, Respondent, admitted accessing the websites at work, and further admitted an addiction to internet pornography."

After it was discovered he had viewed child pornography, records show Zweifach -- who ceased working at Kaiser Permanente in 2007 -- voluntarily suspended his practice, but the board did not order him to surrender his license until this December. The board also required Zweifach to register as a sex offender.

Kaiser Permanente's Charlie David Morgan, Ph.D. angry because SEIU Threatens To Dissolve CKPU

SEIU Threatens To Dissolve CKPU
Adios Andy
December 8, 2009

The Coalition of Kaiser Permanente Unions is the group of unions that, along with KP management, make up the Labor-Management Partnership which was so instrumental in bringing KP up out of the ashes of the strikes in the late 1980's. SEIU is evidently so afraid of losing its monopoly position within KP that they are threatening to sunder the entire coalition, rather than to admit NUHW as a member in that coalition...One of the members of the SoCal KP units wrote a letter to the Executive Director of the CKPU regarding SEIU's threat...

Mr. August,

I am a Kaiser employee, Clinical Psychologist, and currently a UHW member. I have been very involved in LMP as a UBT member both locally and regionally, LMP co-lead, and trained LMP facilitator, and highly value the LMP process. I received your statement today from the CKPU regarding membership to CKPU and participation in LMP.

Firstly let me say that I have always respected your work with Kaiser and LMP. You have done wonderful things in the past to bring employees and managers together to discuss ways to make Kaiser the best place it can be for our health plan members and for employees.

Today however I am very disappointed with your statement and decision. I certainly do understand that Andy Stern is the head of CKPU and you are under his employ, and as such are in a difficult position to follow his demands or lose your job.

You should know that we as members ARE supporting NUHW and WILL win our decertification vote because we have been very disappointed with the direction Andy Stern and the UHW trustees have taken our union and do not agree with their policies, corporate unionism, and back-door deals with management.

I am very disturbed that you do not support our members' right to determine which union we want to represent us. You are threatening that if we choose NUHW through a federal legal process, exercising our rights, that you will not allow us to be part of CKPU or LMP.

Is not a union made up of it members and members voices? Is not unionism a democratic process where we as members have a right to take their union in the direction we feel is best for us and for those we serve? Does not LMP consist of union members (no matter which union) working together with management for the good of all?

I just don't understand how banning NUHW from participation does anyone any good. It does not benefit CKPU, LMP, Kaiser, or any of the other unions in the coalition. It is simply one more of Mr. Stern's scare tactics to not lose his union members.

As of today I have lost all respect for you and see now that you are simply a puppet in Mr. Stern's hands to manipulate and carry out his agenda within Kaiser. I don't think you understand that you are dealing with intelligent, highly educated professionals within these three professional bargaining units, who are not going to be fooled by SEIU (and now CKPU) propaganda and will not fall to your threats.

Charlie Morgan, Ph.D.
Clinical Psychologist
Kaiser Permanente San Diego

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.]