Connecticut Mental Health Lawsuit Takes Insurers To Task

High Co-pays and issue in High Profile Case

By JAY STAPLETON
Connecticut Law Tribune
Originally published July 12, 2013

A Connecticut law firm has taken the lead in a high-profile federal lawsuit that accuses a group of insurance companies of overcharging for mental health services, prompting thousands of vulnerable patients to avoid treatment.

In the American Psychiatric Association v. Anthem Health Plans lawsuit, the firm of Murtha Cullina was hired as chief legal counsel for the plaintiffs. Attorney Marie Pepe VanDerLaan of the firm's Hartford office, the lead lawyer in the case, filed the complaint on the APA's behalf in U.S. District Court in New Haven.

At the heart of the claim is that the insurance company manipulated billing statements in order to charge higher co-pays for patients being treated for mental disorders than those required for patients with physical ailments. The APA is a lead plaintiff in the case, joined by psychologist Susan Savulak of Newington and several of her patients.

The entire article is here.

PA Gay Marriage Ban Faces ACLU Challenge

By Chris Gentilviso
The Huffington Post
Originally published July 9, 2013

Two weeks after the Supreme Court ruled that a federal ban on same-sex marriage is unconstitutional, the American Civil Liberties Union is bringing that decision to the state level.

The Associated Press reported Tuesday that the group is filing a lawsuit against Pennsylvania's same-sex marriage ban. The move will also aim to keep state officials from mounting further challenges against same-sex couples seeking to marry.

The entire story is here.

Editorial note: I would never have imagined that folks in Pennsylvania would be this progressive.

US sues Novartis in NY again, cites doc kickbacks

By The Associated Press at The Wall Street Journal
Originally published on April 26, 2013

The U.S. government sued Novartis Pharmaceuticals Corp. again on Friday, saying it paid kickbacks for a decade to doctors to steer patients toward its drugs, sometimes disguising fishing trips off the Florida coast and trips to Hooters restaurants as speaking engagements for the doctors.

The lawsuit in U.S. District Court in Manhattan came two days after the government brought a similar lawsuit against Novartis, which is based in East Hanover, N.J.

The first lawsuit said the company paid kickbacks to pharmacies to switch kidney transplant patients from competitors' drugs to its own.

In the second lawsuit, the government accused the company of using from 2001 through 2011 multimillion-dollar "incentive programs" that targeted doctors willing to accept illegal kickbacks to urge patients to use the company's drugs.

"And for its investment, Novartis reaped dramatically increased profits on these drugs, and Medicare, Medicaid and other federal health care programs were left holding the bag," U.S. Attorney Preet Bharara said in a statement.

Novartis President Andre Wyss said the company disagreed with the way the government characterized its conduct and stands behind its compliance program.

The entire story is here.

Physicians and Malpractice Data

On Average, Physicians Spend Nearly 11 Percent Of Their 40-Year Careers With An Open, Unresolved Malpractice Claim

By Seth A. Seabury, Amitabh Chandra, Darius N. Lakdawalla, and Anupam B. Jena

Abstract

The US malpractice system is widely regarded as inefficient, in part because of the time required to resolve malpractice cases. Analyzing data from 40,916 physicians covered by a nationwide insurer, we found that the average physician spends 50.7 months—or almost 11 percent—of an assumed forty-year career with an unresolved, open malpractice claim. Although damages are a factor in how doctors perceive medical malpractice, even more distressing for the doctor and the patient may be the amount of time these claims take to be adjudicated. We conclude that this fact makes it important to assess malpractice reforms by how well they are able to reduce the time of malpractice litigation without undermining the needs of the affected patient.

The research can be found here.

Thanks to Ken Pope for this information.

Medical malpractice: Why is it so hard for doctors to apologize?

Fixing a system built on blame and revenge will require bold ways of analyzing mistakes and a radical embrace of openness.

By Dr. Darshak Sanghavi
The Boston Globe
Originally posted on January 27, 2013


DANIELLE BELLEROSE WENT THROUGH HELL for two years trying to conceive, undergoing nine rounds of fertility treatments before she finally got pregnant with twins in late 2003. Shortly thereafter, the then 28-year-old nurse and Massachusetts native developed a complication that required months of bed rest at home. Suddenly, on a June night nearly three months before her due date, Danielle’s uterus began bleeding profusely. At 4:56 a.m. she had an emergency caesarean section at Beth Israel Deaconess Medical Center. Her daughters, Katherine and Alexis, entered the world weighing only about 3 pounds each.

Everything seemed to go well until the end of the first week. When Danielle and her husband, John, visited the unit, Alexis looked fine, but Katherine appeared mottled and pale. Panicked, Danielle found a nurse, and testing confirmed that Katherine was in profound shock due to necrotizing enterocolitis, a devastating intestinal complication that affects premature babies. The infant’s blood had turned acidic. An X-ray indicated a tear in her bowel. Just after midnight, Katherine was taken by ambulance to Children’s Hospital Boston.

Extremely premature infants such as Katherine and Alexis are entirely unprepared to live outside their mother’s womb. After only 30 weeks of gestation, the newborn heart isn’t fully developed, and the intestines can’t easily digest breast milk or formula. At that age, a baby’s brain often doesn’t remember to breathe. In 1963, when President John F. Kennedy’s son, Patrick, was born prematurely, the only thing to do was “monitor the infant’s blood chemistry,” as a newspaper of the day put it. Patrick Kennedy died after two days. By the time Katherine Bellerose was being cared for in the same hospital, however, new treatments had increased survival rates in very low birth weight infants to 96 percent.

Still, at Children’s Hospital, Katherine struggled to survive. Surgeons made a last-ditch effort to save her life by removing her colon, in the hope that this would halt further damage. She failed to improve. Multiple rounds of CPR were performed.

The rest of the story is here.

High court rules online posts didn't defame doctor

The closely watched case tested the boundaries of First Amendment rights vs. reputation.

By ABBY SIMONS
Star Tribune
Originally posted January 30, 2013

Dennis Laurion fired off his screed on a few rate-your-doctor websites in April 2010, along with some letters about what he saw as poor bedside manner by his father's neurologist. He expected at most what he calls a "non-apology apology."

"I really thought I'd receive something within a few days along the lines of 'I'm sorry you thought I was rude, that was not my intent' and that would be the end of it," the 66-year-old Duluth retiree said. "I certainly did not expect to be sued."

He was. Dr. David McKee's defamation lawsuit was the beginning of a four-year legal battle that ended Wednesday when the Minnesota Supreme Court ruled the doctor had no legal claim against Laurion because there was no proof that his comments were false or were capable of harming the doctor's reputation.

The unanimous ruling reverses an earlier Appeals Court decision and brings to an end the closely watched case that brought to the forefront a First Amendment debate over the limits of free speech online.

It's a frustrating end for McKee, 51, who said he's spent at least $50,000 in legal fees and another $11,000 to clear his name online after the story went viral, resulting in hundreds more negative postings about him -- likely from people who never met him. He hasn't ruled out a second lawsuit stemming from those posts.

"The financial costs are significant, but money is money and five years from now I won't notice the money I spent on this," he said. "It's been the harm to my reputation through the repeated publicity and the stress."

He said he offered to settle the case at no cost after the Supreme Court hearing. Laurion contends they couldn't agree on the terms of the settlement, and said he not only deleted his initial postings after he was initially served, but had nothing to do with subsequent online statements about McKee.

Opinion vs. reputation

The lawsuit followed the hospitalization of Laurion's father, Kenneth, for a hemorrhagic stroke at St. Luke's Hospital in Duluth. Laurion, his mother and his wife were also in the room when McKee examined the father and made the statements that Laurion interpreted as rude.

After his father was discharged, he wrote the reviews and sent the letters.

On at least two sites, Laurion wrote that McKee said that "44 percent of hemorrhagic strokes die within 30 days. I guess this is the better option," and that "It doesn't matter that the patient's gown did not cover his backside."

Laurion also wrote: "When I mentioned Dr. McKee's name to a friend who is a nurse, she said, 'Dr. McKee is a real tool!'"

McKee sued after he learned of the postings from another patient. A St. Louis County judge dismissed the lawsuit, saying Laurion's statements were either protected opinion, substantially true or too vague to convey a defamatory meaning. The Appeals Court reversed that ruling regarding six of Laurion's statements, reasoning that they were factual assertions and not opinions, that they harmed McKee's reputation and that they could be proven as false.

The Supreme Court disagreed. Writing the opinion, Justice Alan Page noted that McKee acknowledged that the gist of some of the statements were true, even if they were misinterpreted.

Page added that the "tool" statements also didn't pass the test of defaming McKee's character. He dismissed an argument by McKee's attorney, Marshall Tanick, that the "tool" comment was fabricated by Laurion and that the nurse never existed.

Whether it was fabricated or not was irrelevant, the court ruled.

"Referring to someone as 'a real tool' falls into the category of pure opinion because the term 'real tool' cannot be reasonably interpreted as stating a fact and it cannot be proven true or false," Page wrote.

The entire story is here.

SPLC files groundbreaking lawsuit accusing conversion therapy organization of fraud

Press Release

November 27, 2012

The Southern Poverty Law Center filed a first-of-its-kind lawsuit today accusing a New Jersey organization of consumer fraud for offering conversion therapy services – a dangerous and discredited practice that claims to convert people from gay to straight.

The lawsuit, filed in the Superior Court of New Jersey, charges that Jews Offering New Alternatives for Healing (JONAH), its founder, Arthur Goldberg, and counselor Alan Downing violated New Jersey’s Consumer Fraud Act by providing conversion therapy claiming to cure clients of being gay.

It is the first time a conversion therapy provider has been sued for fraudulent business practices. The lawsuit describes how the plaintiffs – four young men and two of their parents – were lured into JONAH’s services through deceptive practices.

“JONAH profits off of shameful and dangerous attempts to fix something that isn’t broken,” said Christine P. Sun, deputy legal director for the SPLC. “Despite the consensus of mainstream professional organizations that conversion therapy doesn’t work, this racket continues to scam vulnerable gay men and lesbians out of thousands of dollars and inflicts significant harm on them.”

The lawsuit describes how the underlying premise of conversion therapy – that a person can “convert” to heterosexuality – has no basis in scientific fact. Conversion therapy has been discredited or highly criticized by all major American medical, psychiatric, psychological and professional counseling organizations. It is the longstanding consensus of the behavioral and social sciences that homosexuality is a normal and positive variation of human sexual orientation.

Customers of JONAH’s services typically pay a minimum of $100 for weekly individual counseling sessions and another $60 for group therapy sessions. The lawsuit describes sessions that involved clients undressing in front of a mirror and even a group session where young men were instructed to remove their clothing and stand naked in a circle with the counselor, Downing, who was also undressed. Another session involved a subject attempting to wrest away two oranges, which were used to represent testicles, from another individual.

“Sadly, there is no accountability for those who practice conversion therapy,” said Michael Ferguson, a conversion therapy survivor and plaintiff in the lawsuit. “They play blindly with deep emotions and create an immense amount of self-doubt for the client. They seize on your personal vulnerability, and tell you that being gay is synonymous with being less of a man. They further misrepresent themselves as having the key to your new orientation.”

The entire press release is here.

Thanks to Gary Schoener for this information.

Ohio Doctor Can Be Sued in Inmate’s Suicide: Update

Insurance Journal
Originally published August 29, 2012

A psychiatrist is not immune from being sued for damages by the family of a teenage inmate who killed himself in prison, a federal appeals court has ruled.

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The lawsuit stems from the March 2007 suicide of 19-year-old Timothy Hughes, who hanged himself from his bunk with a sheet in Butler County Prison after a social worker at the facility denied him access to Tepe to talk about his depression, history of suicide attempts and medication needs, according to the lawsuit.

The entire story is here.

Alzheimer's research fraud case set for trial

By Toni Clarke
Reuters Health News
Last updated May 11, 2012

Two Harvard teaching hospitals and a prominent Alzheimer's disease researcher accused of using falsified data to obtain a government research grant are set to stand trial after a federal appeals court said this week that a lower court erred when it dismissed the case.

The lawsuit accuses Marilyn Albert, a former professor of psychiatry at Harvard Medical School, and Massachusetts General Hospital (MGH), where she was conducting research, of submitting a grant application based on manipulated data.

The data showed results from a trial were scientifically significant when in fact they were not, according to the lawsuit.

Brigham and Women's Hospital, which collaborated on the research, is also a defendant in the case. The lawsuit was brought in 2006 under the False Claims Act, a 150-year-old federal law designed to recover government funds appropriated through fraud.

This is the first time a lawsuit dealing with alleged scientific fraud has been allowed to progress to trial under the False Claims Act, according to Michael Kohn, a lawyer with Kohn, Kohn & Colapinto in Washington, D.C.

The entire story is here.

New Orleans psychologist sues over negative Angie's List comments

By Michelle Keahey
The Lousiana Record
Originally published May 28, 2012

A New Orleans psychologist has filed a lawsuit against a Florida doctor for negative comments posted on the website Angie's List.


John C. Courtney, Psy D., MP filed the lawsuit against Dr. Bartholomew Vereb and Angie's List Inc. on March 9 in federal court in New Orleans.
 
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Angie's List is accused of negligence for failing to follow its own procedures that would have prevented Courtney's damages, for breaching its duty to Courtney, and for acting with reckless disregard for the truth.

The entire story is here.

Thanks to Ken Pope for this information.

Providers to Test Power of Apology in Malpractice Claims

By Robert Lowes

Medscape Medical News

Originally published April 27, 2012

The Massachusetts Medical Society (MMS) wants to prove that clinicians and hospitals can keep medical malpractice out of the courtroom by owning up to their mistakes with apologies — and sometimes cash as well.

The result, says the MMS, will be not only fewer lawsuits but also improved patient safety, less defensive medicine, and lower costs.

Earlier this month, the MMS and 5 other state healthcare organizations announced the start of a pilot program to promote a process called Disclosure, Apology, and Offer, or DA&O. It's a kinder and gentler approach to medical liability reform compared with measures such as caps on noneconomic (pain and suffering) and punitive damages, which are viewed in some quarters as abridging the legal rights of patients.

Like most of organized medicine, MMS supports these traditional liability reforms, but it also sees merit in avoiding the courts.

"The current liability system impedes open communication," says Alan Woodward, MD, a past MMS president and chair of its professional liability committee. "It creates a culture of blame, finger-pointing, and secrecy. We're trying to turn that around into an advocacy system that supports both patients and providers."

The entire article is here.

Thanks to Gary Schoener for this lead.

Preventing Suicide on Campus May Mean Fences and Nets as Well as Counseling

Chronicle of Higher Education

By Michael Stratford

Originally published March 25, 2012

The families of students who die by suicide often seek to hold colleges responsible.

Lawsuits typically claim that an institution failed to pick up on warning signs or to adequately protect a student whom campus officials knew to be suicidal.

Far less often does a legal action cite, say, the absence of fences on a bridge.

But a lawsuit now pending against Cornell University in federal court takes that approach: It argues that the institution didn't do enough to restrict access to a particular means of suicide.

Specifically, Howard I. Ginsburg alleges that Cornell was negligent for not having installed barriers on the campus bridge where, in February 2010, his son, Bradley, jumped to his death.

A judge this month rejected the university's effort to have the suit dismissed, ruling that the case could continue.

Limiting access to certain methods of suicide, a strategy known as means restriction, has been gaining traction among mental-health researchers.

Some suicides can be prevented, the logic goes, if it's more challenging for an impulsive individual to harm himself.

But on most campuses, that strategy has not taken hold.

 Instead, counseling and education tend to be the centerpiece of suicide-prevention efforts.

 Only at a few institutions, mainly where students' suicides have made headlines in recent years--like Cornell, New York University, and the Massachusetts Institute of Technology--have administrators acted, beyond locking doors to roofs, to significantly alter physical elements of the campus in the name of prevention.

<snip>

For not taking steps to block bridge suicides, the lawsuit says, both Cornell and the city were "negligent, careless, and reckless in failing to provide for safety and protection for vulnerable or impulsive individuals."

University and city officials, Mr. Ginsburg argues, knew that area bridges were a recurring site of suicides and therefore had an obligation to restrict access to them.

Cornell says it is "vigorously" fighting the suit, which Mr. Ginsburg filed in November.

The entire story is here.

A subscription to Chronicle of Higher Education is needed for the full article.

Thanks to Ken Pope for this information.

A Bizarre Outcome on Generic Drugs

The New York Times
The Opinion Pages – Editorial
Originally published March 23, 2012

Dozens of suits against drug companies have been dismissed in federal and state courts because of a decision by the Supreme Court last year that makes it virtually impossible to sue generic manufacturers for failing to provide adequate warning of a prescription drug’s dangers. This outrageous denial of a patient’s right to recover fair damages makes it imperative that Congress or the Food and Drug Administration fashion a remedy.

This situation is particularly bizarre because patients using the brand-name drug can sue when those using the generic form of the drug cannot, as explained by Katie Thomas in The Times on Wednesday. In 2008, the Supreme Court ruled that a Vermont woman who had her hand and forearm amputated because of gangrene after being injected with a brand name antinausea drug could sue the manufacturer for inadequate warning of the risks; she won $6.8 million from Wyeth.

The entire editorial is here.

TRICARE Breach Victims Report Fraud

8 Class Action Lawsuits Pending
Consolidation Sought


By Howard Anderson

healthcareinfosecurity.com

In the weeks following last year's TRICARE health information breach, some of the 4.9 million beneficiaries affected became victims of financial fraud tied to their credit cards or banking accounts. That new detail is included in an amended complaint tied to the original classaction lawsuit filed in the case, which claims the financial fraud is related to the breach incident.

Eight class action lawsuits have now been filed in the wake of the case. The breach involved the theft of unencrypted computer tapes containing personal information, including Social Security numbers, but not financial data, about TRICARE beneficiaries, officials with the military health program said last year. 

The entire story is here.

Legal Risks of Going Paperless

By Alicia Gallegos

amednews.com

Originally published March 5, 2012

Defense attorney Catherine J. Flynn knows how electronic medical records can overwhelm — and often change — the course of a medical liability lawsuit.

In one of her cases, a New Jersey doctor being sued for medical negligence has been accused by a plaintiff’s attorney of modifying a patient’s electronic history. A printing glitch caused the problem, Flynn said, but the accusation has meant extra time and defense costs. Computer screen shots were reviewed, more evidence was gathered and additional arguments were made.

“This has taken a life of its own, and we’ve done virtually no discovery on the medical aspects of the case,” she said. “The cost of the e-discovery alone is in excess of $50,000.”

System breaches. Modification allegations. E-discovery demands. These issues are becoming common courtroom themes as physicians transition from paper to EMRs, legal experts say. Not only are EMRs becoming part of medical negligence lawsuits, they are creating additional liability.

Across the country, the move from paper to electronically stored health data is growing. The 2009 federal stimulus package provided federal funds for the creation of a health information technology infrastructure. Health professionals can receive up to $44,000 for Medicare or nearly $64,000 for Medicaid by adopting electronic medical records.

Studies are mixed about how EMRs will impact liability for physicians. A 2010 survey by Conning Research and Consulting, an insurance industry research firm, found that most insurers believe medical claims will rise during the move from paper to electronic records. Lawsuits probably will decrease after an adjustment period, the study said. A report in the Nov. 18, 2010, issue of The New England Journal of Medicine said doctors should expect a varied landscape of liability risks and benefits as EMR adoption unfolds.

Whatever the future holds for EMRs, it’s important that doctors reduce their liability risks during system implementation, legal experts say. Being aware of potential legal pitfalls prevents doctors from falling victim to technology intended to do good — not cause hardship.

“It’s all about the system that’s in place and the integrity of that system,” Flynn said. “You can only do what the system allows you to do. If you have a good system in place, then the doctors are protected — even from themselves.”

The entire story is here.

Woman’s psychiatrist implanted horrific false memories

By Nightdesk, Herald-Tribune
Health and Fitness

The memories that came flooding back were so horrific that Lisa Nasseff says she tried to kill herself: She had been raped several times, had multiple personalities and took part in satanic rituals involving unthinkable acts. She says she only got better when she realized they weren’t real.

Nasseff, 31, is suing a suburban St. Louis treatment center where she spent 15 months being treated for anorexia, claiming one of its psychologists implanted the false memories during hypnosis sessions in order to keep her there long-term and run up a bill that eventually reached $650,000. The claims seem unbelievable, but her lawyer, Kenneth Vuylsteke, says other patients have come forward to say they, too, were brainwashed and are considering suing.

“This is an incredible nightmare,” Vuylsteke said.

Castlewood Treatment Center’s director, Nancy Albus, and the psychologist, Mark Schwartz, deny the allegations. Albus pledged to vigorously fight the lawsuit, which was filed Nov. 21 in St. Louis County and seeks the repayment of medical expenses and punitive damages. As in repressed memory cases, which typically involve allegations of abuse that occurred during childhood, the outcome will likely hinge on the testimony of experts with starkly different views on how memory works.

Nasseff, who lives in St. Paul, Minn., stayed at Castlewood from July 2007 through March 2008 and returned for seven months in 2009. She was struggling with anorexia and as a resident of Minnesota, which requires insurers to cover long-term eating disorders, she could afford to stay at the center, which sits on a high bluff in the suburb of Ballwin overlooking a park and meandering river. Most states, including Missouri, don’t require such coverage.

The entire story is here.

Third-party cases pose liability risks to doctors

By Alicia Gallgos

amdnews.com staff

The Utah Supreme Court is reviewing whether the children of a patient can sue their father's physician for medication mismanagement after the patient shot his wife to death. In a similar case, the Supreme Court of Georgia has ruled that a psychiatrist can be sued for medication negligence after a patient fatally attacked his mother.

The cases raise concerns about doctors' potential liability for criminal actions committed by their patients and what duty, if any, physicians owe to nonpatients. Experts say the cases remind doctors to take note of circumstances that could increase their liability risk to third parties.

In the Georgia case, the father of Victor Bruscato filed a lawsuit on behalf of Victor against psychiatrist Derek O'Brien, MD. He alleged that the doctor's discontinuation of Bruscato's two antipsychotic medications aggravated his son's violent tendencies. After the drugs were stopped, Bruscato, a mentally ill patient with a history of violence, stabbed his mother to death.

Dr. O'Brien had ordered two of Bruscato's medications stopped for six weeks to rule out the possibility that Bruscato was developing neuroleptic malignancy syndrome, according to court documents. A trial court dismissed the case in favor of Dr. O'Brien, ruling that public policy does not allow the Bruscatos to benefit from any wrongdoing, namely the killing of Lillian Bruscato. The appeals court reversed the decision.

In its Sept. 12 opinion, the Supreme Court affirmed, allowing the lawsuit to proceed. Though public policy prevents profiting from a wrongdoing in court, an exception exists if a mentally ill patient isn't aware of what he is doing, the court said. Bruscato was never found guilty of a crime; instead, he was ruled incompetent to stand trial and committed to a state mental hospital.

The rest of the story can be found here.

W.Va. board withdraws autism rule after lawsuit

By Lawrence Messina
Associated Press
Published September 27, 2011

The West Virginia board that regulates psychologists voted Tuesday to withdraw an emergency rule that claimed jurisdiction over specialists who treat children with autism, after the new policy spurred a lawsuit and an outcry among parents of these children and their supporters.

The rule issued in July by the state Board of Examiners of Psychologists has been misinterpreted and misunderstood, board Executive Director Jeffrey Harlow said in a statement emailed to the media late Tuesday.

"The parents are calling the board and expressing fear and anger," the statement said, adding that "The last thing the Board would want to do is obstruct the provision of vitally needed services to these vulnerable children."

The rule had barred applied behavioral analysis, a therapy considered crucial for many children diagnosed with an autism spectrum disorder, unless a licensed psychologist supervised the ABA analyst. When it applied for the rule, the board called the providing of this therapy outside its jurisdiction "an immediate threat to public safety."

"There is a relatively small, but most likely soon to increase, group of individuals engaging in the practice of psychology who are not licensed and who do not meet the minimum education and training requirements for licensure," the board wrote when it sought the rule. "They are not prepared to practice independently, lack oversight and constitute a serious and immediate concern to public safety."

A certified ABA analyst, Jill Scarbro-McLaury, sued the board last week, asking a judge to scuttle the rule. Her Kanawha Circuit lawsuit alleged that ABA therapy is separate and distinct from psychology, and has been practiced in West Virginia for years without the board's interference.

"We are encouraged that the board recognized that the rule should be pulled since it was in violation of the law, and we hope no more road blocks are placed in front of our families who just want to help their children," Scarbro-McLaury said in an email.

The board pursued the rule over a new law that will eventually require both public and private insurers to cover ABA therapy. Parents of children with these neurological ailments and their supporters had lobbied the Legislature for several years for the measure. Acting Gov. Earl Ray Tomblin signed the regular session bill into law in April.

The entire story can be read here.

New Jersey Psychologists Fight to End Unlawful Practices of Major Health Insurance Plans

Press Release
The New Jersey Psychological Association
October 13, 2011

NJPA Sues Horizon and Magellan for Violating Patient Privacy and Breaking Contractual Obligations

The New Jersey Psychological Association (NJPA), which represents approximately 2,000 psychologists throughout the state, has filed a lawsuit in conjunction with two patient co-plaintiffs against Horizon Healthcare Services, Inc. and Magellan Health Services. The suit seeks a declaration that Horizon and Magellan have violated patient confidentiality rights and breached the terms of their plan documents by systematically and wrongfully requiring psychologists to disclose confidential patient information to secure authorization for payment for mental health treatment.

The suit alleges that defendants' practices not only contradict the plan documents of the State Health Benefits Plan, the largest insurance plan in the state, but also violate state and federal laws protecting patient privacy. NJPA filed the suit to preserve and protect the rights of its members and its members' patients, who are directly affected by Horizon's and Magellan's actions.

"The skill and support of my psychologist were crucial when I was dealing with a deeply personal and challenging time in my life," said Steven Sargese, a retired law enforcement officer in Essex County and a co-plaintiff in the lawsuit. "Unfortunately, my health plan repeatedly denied the full course of treatment recommended by my psychologist. I'm determined to stand up for people who need mental health services and cannot stand up for themselves."

The entire story can be read here.

The New Jersey Psychological Association website is here.

Ghostwritten medical articles called fraud

CBC News

It's fraudulent for academics to give their names to medical articles ghostwritten by pharmaceutical industry writers, say two Canadian law professors who call for potential legal sanctions.

Studies suggest that industry-driven drug trials and industry-sponsored publications are more likely to downplay a drug's harms and exaggerate a drug's virtues, said Trudo Lemmens, a law professor at the University of Toronto. The integrity of medical research is also harmed by ghostwritten articles, he said.

Ghostwriting is part of marketing that can distort the evidence on a drug, Lemmens said. Industry authors are concealed to insert marketing messages and academic experts are recruited as "guest" authors to lend credibility despite not fulfilling criteria for authorship, such as participating in the design of the study, gathering data, analyzing the results and writing up of the findings.

Class actions involving drugs such as Vioxx, hormone replacement therapy and antidepressants suggest guest authors often fail to meet criteria for authorship, according to the policy paper in Tuesday's issue of Public Library of Science's journal PloS Medicine.

In the article, Lemmens and his colleague Prof. Simon Stern argue that legal remedies are needed for medical ghostwriting since medical journals, academic institutions and professional disciplinary bodies haven't succeeded in enforcing sanctions against the practice.

The institutions have divided loyalties, the authors say, which may explain why they've been slow to act. For example, universities wish to protect academic integrity while also protecting their employees from unjust accusation.

A legal response could act as a powerful deterrent, Stern said.

"Our theory does not depend on the accuracy of the data," Lemmens said in an email. "False representation of authorship is in our view fraud, regardless of the accuracy of the reporting."

Doctors and patients perceive published studies to be independent assessments made by academic experts, the authors noted.

Ghostwritten publications are used in court to support a manufacturer's arguments about a drug's safety and effectiveness, and academic experts who appear as witnesses for pharmaceutical and medical device companies also boost their credibility with the publications on their CV, Lemmens said.

The entire story can be found here.