Psychiatrist Fired by Kaiser Sues Over Prescribing Practices

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San Francisco Chronicle

ALAMEDA COUNTY, CA- A former Kaiser psychiatrist has filed suit against the HMO in state court, charging that he was fired after refusing to prescribe medications to patients he was not allowed to personally examine.

According to documents filed Monday in Alameda County Superior Court, Dr. Thomas S. Jensen said the Permanente Medical Group in San Diego terminated him in February after he refused to go along with the practice of prescribing medications to patients solely on the recommendations of social workers who saw them when they came into the clinic.

Permanente employs the doctors who treat Kaiser patients. The lawsuit was filed against Permanente and the Kaiser Foundation Health Plan, which is the HMO.

Jensen’s lawsuit does not ask for reinstatement or damages for his alleged firing. Instead, the San Diego psychiatrist has asked the California courts to issue an injunction that would stop Kaiser Permanente from requiring other doctors to prescribe drugs without personally examining patients.

The suit also charges Kaiser with engaging in “untrue or misleading advertising” by proclaiming that it leaves treatment “in the hands of doctors” when — according to the suit — it forces doctors in Southern California “to prescribe drugs based solely on the report of a nonphysician social worker, social work intern or like employee.”

Officials at Kaiser‘s Oakland headquarters referred calls to Dennis Cook, chief of the psychiatry practice for the Southern California Permanente Medical Group. He could not be reached.

Jensen’s case is reminiscent of a class-action lawsuit filed against Kaiser last year by the Santa Monica-based Consumers for Quality Care, a public interest group associated with Ralph Nader.

That suit also alleged that Kaiser‘s ads were misleading because they say the HMO leaves doctors in charge of treatment when administrators allegedly interfere. But Jamie Court, the activist who brought that suit, said Jensen’s charges were more damaging.

“This is a Kaiser physician saying he doesn’t even have the authority to see a patient,” Court said. “This is a huge ethical breach.”

Michael Ashcraft, a retired physician who is now a staff member with the state Senate’s insurance committee declined to discuss the particulars of this case, but he did explain what is usual practice regarding prescriptions in group practice settings such as Kaiser clinics.

Ashcraft said it is common for social workers, under the supervision of a psychiatrist, to screen patients and make recommendations for treatments or medications.

“But once the doctor makes the decision that he needs to make a physical exam before prescribing, that’s it, it’s his duty,” Ashcraft said. “I’m not aware of a situation where someone would tell a physician they couldn’t examine a patient.”

In his lawsuit, however, Jensen said he was terminated after four months for insisting that, in his medical judgment, he had to see some patients before following the prescription recommendations of the social workers.

Chronicle staff writer Henry K. Lee contributed to this report.

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