San Diego Education Report
Thank Heaven for
Insurance Companies blog
A Letter from Douglas Beech, M.D.
While reading about the outcome of Dr. Thomas Jensen’s suit against
Kaiser Permanente’s San Diego HMO in the October 6 issue, I was painfully
reminded just how far the collective mentality of psychiatry has plunged into
a managed care paradigm of minimalism.

Dr. Jensen protested the policy of the HMO that "required" psychiatrists to
prescribe without personal examination of a patient. Physicians who
participate in such a practice do not have the HMO policy to blame, but the
outcry suggested that the policy was responsible for physicians’ not
performing their required duty.
Please read:

Kaiser Defends Mental Health Coverage As 'team-

LOS ANGELES, Apr 14 (Reuters) - Kaiser Permanente, under
investigation in California for requiring psychiatrists to write drug
prescriptions for mental health patients whom they have not seen,
on Thursday defended its practice as "team-based."

The California State Department of Corporations is investigating Kaiser, the
nation's largest nonprofit health maintenance organization, after a
complaint from a psychiatrist who alleges that he was fired for refusing to
write prescriptions for patients he had not examined. "The model used in
the Kaiser Permanente San Diego department of psychiatry is a team-
based approach to providing quality mental health care services to health
plan members,"
Dr. Joel Hyatt, assistant associate medical director of
Kaiser's Southern California medical group,
said in a statement.

"We believe that some who have expressed concern about our practice are
not fully aware that our patients are very carefully screened, that this
represents a carefully structured process designed by physicians, and that
all decisions ”to examine the patient or to prescribe medication” are made
by physicians," Dr. Hyatt said.

The California department, which regulates managed care, has said that it
plans to hold an inquiry into the matter.

The complaint, filed by San Diego psychiatrist Dr. Thomas
alleges that, as a matter of practice, psychiatrists are
required by Kaiser to prescribe medications for depression and
anxiety on the recommendation of nonmedically qualified
personnel, such as psychotherapists, social workers and even
intern social workers, without ever examining the patients.

Dr. Hyatt said that Kaiser's new patients are carefully screened by a
licensed clinical social worker, licensed family therapist or clinical
psychologist. A psychiatrist then reviews the assessment, and, in cases
where a patient is presenting with mild depression or anxiety, the
psychiatrist might prescribe a starter dosage of appropriate medication and
then personally examine the patient in about 3 to 4 weeks. "The personnel
who conduct the initial assessment are licensed mental health professionals
who work closely with the psychiatrists in their unit. They do not prescribe
independently, and do not make diagnoses or prescribing
recommendations to the psychiatrists," he said. Dr. Jensen has also filed a
lawsuit in Alameda County Superior Court in northern California, where
Kaiser has its headquarters, seeking an injunction to force the company to
end the practice.
Dr. Jensen told the Los Angeles Times that on his
first day at work with Kaiser, he was presented with cases by social
workers, social work interns and marriage and family therapists who
recommended drug treatments for patients they had diagnosed.

According to California law and the American
Psychiatric Association code of ethics, the prescribing
of drugs by a physician without "good faith" prior
examination by that physician is classed as
"unprofessional conduct."

Copyright © 1999 Reuters Ltd. All rights reserved.

Kaiser [Says] Ends Medication Policy May 5, 2000

LOS ANGELES (AP) - Health maintenance organization Kaiser Permanente
has ended a policy that requires psychiatrists to prescribe depression and
anxiety medications for patients they haven't examined.

Kaiser psychiatrists must now rely on their own examination of patients
before writing prescriptions, the HMO announced Tuesday.

Kaiser is the nation's largest not-for-profit HMO, serving 8 million members
in 11 states and the District of Columbia. Almost 6 million of its patients are
in California.

A former Kaiser psychiatrist, who said he was fired for not following the old
policy, filed a lawsuit last month that drew national attention and prompted
the state Department of Corporations to begin investigating the drug

The lawsuit, filed by Dr. Thomas S. Jensen of San Diego, sought to halt
Kaiser's prescription policy, which were often delivered at the behest of
social workers or family therapists.

Critics said prescriptions from absentee psychiatrists endanger mental
patients and violate ethics codes of the American Psychiatric Association.

Dr. Oliver Goldsmith, medical director for Southern California
Permanente Medical Group,
said Tuesday the HMO decided to review its
policy amid the public outcry.

"The public attention was a stimulus for us to take another look at this
practice," Goldsmith said. ``We felt that this was a street we had to come
back from."

However, Goldsmith maintained no patients were harmed by the
previous policy, which was restricted to Kaiser's psychiatric clinics
in the San Diego area. About 24,000 patients were treated there last
year, he said.

Kaiser acknowledged its old policy differed from standards
generally accepted by the psychiatric community, but said the
practice was designed to allow psychiatrists to treat more patients.

Jensen's attorney, Cliff Palefsky of San Francisco, cautioned that his client
would not drop the lawsuit against Kaiser until he sees changes that are
"real and complete."

Meantime, a spokeswoman for the Department of Corporations said the
agency intends to continue its investigation.
Former Kaiser Permanente
Physician, Dr. Daniel Trussell
speaking on the
Highway2Health, November 9,
2004 program about the
overuse of psychotropics, the
testing of them and the reality
how patients might
unnecessarily be
encouraged to use them
to quite frankly, shut them
 This program is titled "A
Candid Conversation on
Psychotropic Medications and
The Current State of
Psychiatry" by Dr. Daniel

More of Dr. Trussell presentations are
located at:
Kaiser Mental Health:
overusing medication?
Before you switch insurance
companies make sure you
are off any and all
anti-depressants! -
When Amy M. left her steady
job to become a freelance
advertising copywriter,she had
no idea the antidepressant
she took to combat depression
would have an unexpected
side effect. She couldn't get
health insurance.

"I was turned down by Blue
Cross, Blue Shield and Kaiser,"
said the 35-year-old Oakland
resident, who has been
taking the antidepressant
Celexa for several years.

"My rejection letters from the
insurance companies
stated the reason for the denial:
Link to story:
Kaiser Permanente is for-
profit and its "mental
health" program is a big
part of achieving that goal

How it started: KAISERGATE

The following is how the HMO's actually
got off the ground and it was never for
your own good. We believe that the
American public has been mislead.
Please follow the following two web
links to learn more about
what took
place between President Nixon,
John Erlichman and how Edgar
Kaiser played a role in the creation
of the HMO.

Presented at the Miller Center of Public
Affairs - University of Virginia - White

Also hear the sound clip of Nixon here:


The transcription has been
mirrored on this site because of its
relevance to Kaiser Permanente
being a for-profit corporation
which is contrary to what they have
publicly claimed to the rest of the
 We cannot imagine what
further proof anyone in this world would
need to have presented that Kaiser is a
for-profit corporation.

We also believe that listening to this
tape will more clearly explain how
Kaiser has manipulated our
government and the public into
believing an untruth.  It appears that
President Nixon knowing full well that
Kaiser was not being honest with their
presentation of the HMO thought he
was using this to his advantage.  
Unfortunately it has taken decades for
this to become public knowledge which
is a shame.  President Nixon knew from
the time of this conversation that Kaiser
was for-profit and he also knew that
they are able to profit because --
the incentives are toward less
medical care, because—the less
care they give them, the more
money they make." - Mr.
Erlichman quoting Edgar Kaiser
to President Nixon on February
17, 1971...
The Beginning of the
Health Benefit

The following is from "Nicholas
A. Cummings Collected Papers
Vol. I" - Page 128 - 129
Note:  Nicolas A. Cummings led
the Behavioral Health Division
and worked it into a money
making enterprise.  He also is
the person that made sure
psychiatric services were
provided by HMO's.  That
sounds good doesn't it?  Read
the following to learn the
motives behind the actions:

"Kaiser Permanente soon
found, to its dismay, that once a
health system makes it easy
and free to see a physician,
there occurs an alarming
inundation of medical utilization
by seemingly physically health
persons.  In private practice the
physician's fee has served as a
partial deterrent to
over-utilization, until the recent
growth of third party payment
for health care services.  The
financial base at Kaiser
Permanente is one of per
capitation, and neither the
physician nor the Health Plan
derives an additional fee for
seeing the patient.  Rather than
becoming wealthy from
imagined physical ills, the
system could be bankrupted by
what was regarded as abuse by
the hypochondriac.

Early in its history, Kaiser
Permanente added
psychotherapy to its list of
services, first on a courtesy
reduced fee of five dollars per
visit and eventually as a
prepaid benefit.  This was
initially motivated not by a belief
in the efficacy of
psychotherapy, but by the
urgent need to get the so-called
hypochondriac out of the
doctor's office.  From this initial
perception of mental health as
a dumping ground for
bothersome patients, twenty
years of research has led to the
conclusion that no
comprehensive prepaid health
system can survive that does
not provide a psychotherapy

Early investigations confirmed
physicians fears they were
being inundated, for it was
found that 60% of all visits were
by patients who had nothing
physically wrong with them.  
Add to this the medical visits by
patients whose physical
illnesses are stress related
(peptic ulcer, ulcerative colitis,
hypertension, etc.), and the
total approaches a staggering
80 to 90% of all physician visits.
Surprisingly as these findings
were 25 years ago, nationally
accepted estimates today range
from 50 to 80% (Shapiro,
1971)  Interestingly, over 2,000
years ago Galen pointed out
that 60% of all persons visiting
a doctor suffered from
symptoms that were caused
emotionally, rather than
physically (Shapiro, 1971).

Timothy Leary was the
Director of the Kaiser
Foundation Psychological
Research from 1952 to
1958.  He did a lot of
research on how to
control and manipulate a
 He led a wild
lifestyle up at Kaiser where -

"In the mid-1950s Leary worked
as director of Psychological
Research at the Kaiser
Foundation and taught at
Berkeley University. There he
and his wife were involved in
heavy drinking and adulterous
wife swapping.
In early 1960,
he joined the Harvard
Center for Personality
That same year
Leary took his first dosage of
hallucinogenic mushrooms, and
he was permanently changed.
Believing that psilocybin
mushrooms created mystical
perception that could
reprogram the brain, Leary
persuaded the school
authorities to allow him to
devise and administer the
"Harvard Drug Research

There are several variations of
why Tim Leary was fired from
Kaiser. Most of the explanations
sound petty.  Only one sounds
logical and provides a
reasonable explanation.  The
following version is from
Nicholas A. Cummings who
replaced Timothy Leary.  
Quotes are from:  "The
Entrepreneur of Psychology:
The Collected Papers of
Nicholas A. Cummings"  
pages 5 and 6 -
The Role of the Somatizer inb
the Development of the Health

Early in the 1950's, the
Permanente physicians
discovered that 60% of all visits
to physicians were by patients
who either had no physical
illness, or had a physical illness
that was being exacerbated by
psychological factors.  Today,
this is a nationally recognized
phenomenon, and the American
Medical Association (AMA)
accepts 60% to 70%  as the
national figure.  The reason it
was first discovered at Kaiser
Permanente was the nature of
the health plan itself.  See:

The Leary material is  very
important as it sources all that
has followed while providing
somewhat of a road map for
understanding what in the world
these people are really doing.
"Targeting the insurance
companies of the nation is
important to identify the idea
that upstream intervention is
going to save the insurance
dollar. There is cost savings
and the business department  
of Kaiser has data to support

As long as the outcomes are
behaviorally based, we can
measure the outcomes in terms
of reduced medical visits and
reduced medical visits
translates to dollars, savings. "
mirrored at:

Now Learn how this branch of
medicine is used to control,
bribe and sometimes treat
Nixon White House tapes
about Kaiser Permanente

The following transcription is mirrored here
from the University of Virginia because of
the interest to The Justice Department the
Internal Revenue Service and the
American public.  Again I refer everyone
to: http://www.whitehousetapes.
for the clearest possible presentation.

February 17, 1971
5:26 pm - 5:53 pm
Oval Office
Conversation 450-23

John D. Ehrlichman: On the—on the
health business—

President Nixon: Yeah.

Ehrlichman: —we have now narrowed
down the vice president's problems on
this thing to one issue and that is
whether we should include these health
maintenance organizations like Edgar
Kaiser's Permanente thing. The vice
president just cannot see it. We tried 15
ways from Friday to explain it to him
and then help him to understand it. He
finally says, “Well, I don't think they'll
work, but if the president thinks it's a
good idea, I'll support him a hundred

President Nixon: Well, what's—what's
the judgment?

Ehrlichman: Well, everybody else's
judgment very strongly is that we go
with it.

President Nixon: All right.

Ehrlichman: And, uh, uh, he's the one
holdout that we have in the whole

President Nixon: Say that I—I—I'd tell
him I have doubts about it, but I think
that it's, uh, now let me ask you, now
you give me your judgment. You know
I'm not to keen on any of these damn
medical programs.

Ehrlichman: This, uh, let me, let me tell
you how I am—

President Nixon: [Unclear.]

Ehrlichman: This—this is a—

President Nixon: I don't [unclear]—

Ehrlichman: —private enterprise one.

President Nixon: Well, that appeals to

Ehrlichman: Edgar Kaiser is running his
Permanente deal for profit. And the
reason that he can—the reason he can
do it—I had Edgar Kaiser come in—talk
to me about this and I went into it in
some depth. All the incentives are
toward less medical care, because—

President Nixon: [Unclear.]

Ehrlichman: —the less care they give
them, the more money they make.

President Nixon: Fine. [Unclear.]

Ehrlichman: [Unclear] and the
incentives run the right way.
President Nixon: Not bad.

Tape at: http://whitehousetapes.
you need to look for:tape rmn_e450c
It is 12 MGS if using Windows Media Player

The very next day Mr.
Nixon had a message for
Congress proposing a
National Health Strategy.
Read what he said on February 18, 1971:
and mirrored here for historical purposes
and in the event the content is taken down
by the for any

Richard Nixon
Special Message to the Congress
Proposing a National Health Strategy
February 18th, 1971


...This new strategy should be built on
four basic principles.

1. Assuring Equal Access. Although the
Federal Government should be viewed as
only one of several partners in this
reforming effort, it does bear a special
responsibility to help all citizens achieve
equal access to our health care system....

2. Balancing Supply and Demand. It does
little good, however, to increase the
demand for care unless we also increase
the supply...

3. Organizing for Efficiency.... It must be
our goal not merely to finance a more
expensive medical system but to organize
a more efficient one.

There are two particularly useful ways of
doing this:

A. Emphasizing Health Maintenance. In
most cases our present medical system
operates episodically--people come to it in
moments of distress--when they require its
most expensive services...

B. Preserving Cost Consciousness. As we
determine just who should bear the
various costs of health care, we should
remember that only as people are aware
of those costs will they be motivated to
reduce them. When consumers pay
virtually nothing for services and when, at
the same time, those who provide services
know that all their costs will also be met,
then neither the consumer nor the
provider has an incentive to use the
system efficiently...

4. Building on Strengths. We should also
avoid holding the whole of our health care
system responsible for failures in some of
its parts. There is a natural temptation in
dealing with any complex problem to say:
"Let us wipe the slate clean and start from
scratch." But to do this-to dismantle our
entire health insurance system, for
example--would be to ignore those
important parts of the system which have
provided useful service...


In recent years, a new method for
delivering health services has
achieved growing respect. This new
approach has two essential attributes.
It brings together a comprehensive
range of medical services in a single
organization so that a patient is
assured of convenient access to all of
them. And it provides needed
services for a fixed contract fee which
is paid in advance by all subscribers.

Such an organization can have a variety of
forms and names and sponsors. One of
the strengths of this new concept, in fact,
is its great flexibility.
The general
term which has been applied
to all of these units is "HMO"--
"Health Maintenance

The most important advantage of
Health Maintenance Organizations
that they increase the value of the
services a consumer receives for each
health dollar. This happens, first, because
such organizations provide a strong
financial incentive for better preventive
care and for greater efficiency...

A fixed-price contract for comprehensive
care reverses this illogical incentive. Under
this arrangement, income grows not with
the number of days a person is sick but
with the number of days he is well. HMO's
therefore have a strong financial interest
in preventing illness, or, failing that, in
treating it in its early stages, promoting a
thorough recovery, and preventing any
reoccurrence. Like doctors in ancient
China, they are paid to keep their clients
healthy. For them, economic interests work
to re-enforce their professional interests...

In an HMO, in other words, cost
consciousness is fostered.
Such an
organization cannot afford to waste
resources-that costs more money in the
short run. But neither can it afford to
economize in ways which hurt patients for
that increases long-run expenses.

The HMO also organizes medical
resources in a way that is more convenient
for patients and more responsive to their
needs. There was a time when every
housewife had to go to a variety of shops
and markets and pushcarts to buy her
family's groceries. Then along came the
supermarket-- making her shopping
chores much easier and also giving her a
wider range of choice and lower prices.
The HMO provides similar advantages in
the medical field...

Because a team can often work more
efficiently than isolated individuals, each
doctor's energies go further in a Health
Maintenance Organization--twice as far
according to some studies.
At the same
time, each patient retains the freedom
to choose his own personal doctor...

Some seven million Americans are
now enrolled in HMO's--and the
number is growing. Studies show that
they are receiving high quality care at
a significantly lower cost--as much as
one-fourth to one-third lower than
traditional care in some areas. They
go to hospitals less often and they
spend less time there when they go.
Days spent in the hospital each year
for those who belong to HMO's are
only three-fourths of the national

Patients and practitioners alike are
enthusiastic about this organizational
concept. So is this administration.
That is why we proposed legislation
last March to enable Medicare
recipients to join such programs. That
is why I am now making the following
additional recommendations:

1. We should require public and
private health insurance plans to
allow beneficiaries to use their plan to
purchase membership in a Health
Maintenance Organization when one
is available...

2. To help new HMO's get started-an
expensive and complicated task--we
should establish a new $23 million
program of planning grants to aid
potential sponsors--in both the
private and public sector.

3. At the same time, we should
provide additional support to help
sponsors raise the necessary capital,
construct needed facilities, and
sustain initial operating deficits until
they achieve an enrollment which
allows them to pay their own way. For
this purpose, I propose a program of
Federal loan guarantees which will
enable private sponsors to raise
some $300 million in private loans
during the first year of the program.

4. Other barriers to the development
of HMO's include archaic laws in 22
States which prohibit or limit the
group practice of medicine and laws
in most States which prevent doctors
from delegating certain
responsibilities (like giving injections)
to their assistants. To help remove
such barriers, I am instructing the
Secretary of Health, Education, and
Welfare to develop a model statute
which the States themselves can
adopt to correct these anomalies. In
addition, the Federal Government will
facilitate the development of HMO's in
all States by entering into contracts
with them to provide service to
Medicare recipients and other
Federal beneficiaries who elect such
programs. Under the supremacy
clause of the Constitution, these
contracts will operate to preempt any
inconsistent State statutes...
Kaiser Drug Policy
Prompts State Inquiry
April 12, 2000

Kaiser Permanente, the
state's biggest health
organization, routinely
requires its psychiatrists
to prescribe psychiatric
drugs to some mental
health patients whom
they have not personally
examined, a practice that
leading experts say
endangers patients and
violates professional
codes of ethics.

State regulators are
investigating complaints that
Kaiser may be running afoul
of long-established medical
procedures by requiring
psychiatrists to prescribe
medications for depression
and anxiety at the
recommendation of
psychotherapists, such as
social workers and
social-work interns.
Ads by Google

Kaiser PermanenteGet free
health insurance quotes.
Find individual and group

Both California law and the
American Psychiatric Assn.
code of ethics declare that
prescribing drugs without a
"good faith" prior
examination is
unprofessional conduct.

Kaiser's little-known policy
has come under attack in a
lawsuit filed this week by a
former Kaiser psychiatrist
who was fired for refusing
to prescribe medications for
patients whom he did not
personally examine. The
physician, Dr. Thomas S.
Jensen of San Diego, has
asked a state court to halt
Kaiser's practice.

Based on complaints by
Jensen and another Kaiser
psychiatrist in Sacramento,
the state Department of
Corporations has begun
investigating the practice, a
department spokeswoman

Jensen said he told state
regulators that he saw
cases where nonmedical
personnel had
recommended drugs that
could have jeopardized
patients' health.

Kaiser, which has 30 days
to answer the allegations in
Jensen's lawsuit,
acknowledged that its policy
differs from standards
generally accepted by the
psychiatric community. But
Dr. Dennis Cook,
coordinating chief of
psychiatrists for Kaiser's
Southern California
, defended the
procedure, saying that it
allowed Kaiser's
psychiatrists to see more
patients by eliminating a
potentially duplicative initial

Cook said the contention
that the practice was
unethical was self-serving
on the part of psychiatrists
in private practice, who
don't know and trust the
therapists making the
recommendations, and who
stand to make money from
an extra office visit.

"We think it's very
ethical," Cook said.
denied that any injuries
have resulted from Kaiser's

Some of the nation's top
psychiatrists, contacted by
The Times, said Kaiser's
policy of allowing
nonmedical personnel to
examine patients and
recommend drugs stopped
far short of the competent
standard of care.

Social workers, family
therapists and social-work
interns are not trained to
know the risks, benefits and
side effects of psychotropic
drugs, the experts say.

"It's not trivial to put
someone on psychotropic
medications," said Dr.
Joseph T. Coyle, chairman
of the department of
psychiatry at Harvard
Medical School. "If you
haven't evaluated the
patient when you start the
then it's
impossible to follow the
patient and see how [he or
she] is responding to
powerful drugs that could
cause harmful side effects.

"I'm surprised that an
ethical insurer would
require such a practice,"
Coyle said. "They say
California tells what the
future is. I hope that's not
the case for the psychiatric

William Baak, a
psychiatry professor at
UC San Diego School of
Medicine, called the
HMO's policy

"If that's modernity, I don't
want any part of it," Baak

Dr. William Arroyo, a
psychiatry professor at
USC School of Medicine
and a member of the
APA's ethics committee,
said Kaiser's practice
clearly violates the
professional body's code
of ethics.

"This undermines patient
care," he said.

The state investigation and the
whistle-blower suit focus in part on
Kaiser's contention--made in
advertisements--that "physicians
alone manage all aspects of care."

"At Kaiser Permanente,
medical decisions are made
by physicians in
consultation with their
patients, not by health plan
administrators," Kaiser
states on its Web site. The
HMO's doctors "can order
any tests, medications,
medical procedures or
referrals they need without
approval from someone in
the health plan."...
Is it always about profit for Kaiser Permanente?  One
good thing about the profit motive is that if very large
numbers of people are being harmed in ways that
cost Kaiser money, it will do something about it.  
Kaiser loves to prescribe antidepressants, but it
doesn't love to care for autistic patients!

Pregnant question
The possible link of antidepressants to autism has
expectant mothers worried, though the risk may be
By Neena Satija
Boston Globe
July 25, 2011

Try Googling “Prozac pregnancy’’ and you’ll get a
sense of the fear and confusion surrounding the
relationship between the two.

“Anyone with experience on Prozac?’’ asks a woman
on the community page of
Prescribed the antidepressant by her doctor, she
writes, “I’m just really concerned and frankly scared
to take them after reading all these articles and
research. I’m 20 weeks 2 days, and I’m supposed to
start on 10mg of Prozac this morning, but I’m staring
at it right now and I don’t know what to do - should I
take it?’’

In the past decade there has been a flurry of
research into the effects of antidepressants on
pregnancy - in particular, on selective seratonin
reuptake inhibitors (SSRIs), which include Prozac
and are the most commonly prescribed such drugs.
So far, findings published on their possible effects
have been all over the map - from increased
likelihood of pre-term delivery to poor adaptation by
newborns because of withdrawal symptoms from the

This month, a report in the Archives of General
Psychiatry by Kaiser Permanente researchers
suggested that pregnant women who use SSRIs
might increase their likelihood of having a child with
an autism spectrum disorder (autism, Asperger’s
syndrome, or other unspecified pervasive
developmental disorders). Released in conjunction
with a landmark study reporting that environmental
factors may play a much larger role in autism than
previously thought, the findings on antidepressants
have fueled the debate over whether SSRIs can be
harmful during pregnancy. (Some of the same
researchers participated in both studies.)

Between 14 percent and 23 percent of women
experience a depressive disorder while pregnant,
according to a 2009 report by the American
Psychiatric Association and the American College of
Obstetricians and Gynecologists. The numbers are
similar to those for women in the general population.
Left untreated in pregnant women, depression has
been shown to lead to such problems as poor fetal
development and mother-infant bonding, and pre-
term delivery.

What’s an expectant mother to do? How does she
make a decision about whether it’s safe to use
antidepressants when she’s suffering from a
disorder that makes her more anxious to begin with?

“In pregnancy in general, we tend to be afraid of all
medicine,’’ said Dr. Lori Wroble, the chief
obstetrician for Harvard Vanguard Medical
Associates at Newton-Wellesley Hospital. “And I think
it’s actually scarier when you don’t have enough
studies, because it’s an open-ended question that
you’ll always wonder about.’’

There are so many new studies about the possible
effects of medication on pregnancy that physicians
can have trouble keeping up. At Newton-Wellesley,
the Harvard-Vanguard group holds monthly
meetings to discuss research trends - sessions that
helped Wroble decide to usually prescribe sertraline,
the generic equivalent of Zoloft, if her pregnant
patients need medication for depression.

But try Googling “Zoloft pregnancy.’’ One of the first
results? A TV commercial uploaded to YouTube
called “Zoloft and Pregnancy Lawsuit.’’ The minute-
long video lists the birth defects that allegedly have
been linked to Zoloft, complete with background
music of ominous piano chords. The website Zoloft- has added the autism study to its
information page, urging women to call for a free

One of the problems with linking medications to
conditions like birth defects or autism is that while
statistics on risk increases can seem alarming, the
conditions themselves are relatively rare.

“People always concentrate on the risk, but the
probability of having a perfectly healthy, vibrant little
baby is very high,’’ says Dr. Lisa Croen, the study’s
principal author and the director of the autism
research program at Kaiser Permanente in Northern

Croen’s research team looked at the medical
records of 1,805 mothers - 298 had children with
autism, and 1,507 did not. Of the 1,507 mothers, 50,
or 3.3 percent, had received at least one
prescription for an SSRI in the year before giving
birth. Of the 298 mothers with children found to have
an autism-spectrum disorder, 20, or 6.7 percent,
were prescribed SSRIs during the same time period.

Despite those numbers, Croen says that in the
general population of all pregnant women, “99 times
out of 100, you’re going to have a child without an
autism-spectrum disorder.’’ Her study did not prove
that antidepressants during pregnancy increase the
risk of having a child with autism, and even if further
research does establish that link is correct, Croen
said, the odds of having a child without autism “might
be 98 out of 100 times.’’

Another reason it’s difficult to draw conclusions
about the advisability of SSRIs during pregnancy is
that researchers don’t know how to tease apart the
risks of using the antidepressants from the risk
posed by the depression itself.

“It’s very hard to know whether any effect that you
know and see is due to the medications themselves
or to the depression,’’ said Dr. Sengwee Darren Toh,
an instructor at Harvard Medical School whose
research focuses on the effects of different
medications on pregnancy. “I don’t think we have an
answer for that.’’

While the autism study’s design is good, he said, it’s
too preliminary to use for any clinical

So is it worth the risk for a pregnant woman suffering
from depression to take an antidepressant?

The US Food and Drug Administration gives most
SSRIs a “C’’ grade in its categorization for safety of
medications during pregnancy. That means the
drugs have shown adverse effects on fetuses in
animal studies, but there isn’t enough data available
on humans.

(The only exception is paroxetine, the generic
equivalent of Paxil, which the FDA gave a “D’’ after
two studies found that taking the drug early in
pregnancy increased the risk of heart defects in
babies from about 1 percent in the general
population to 1.5-2 percent.)

Still, the FDA notes that the benefits of taking
categories C and D medications may outweigh the

“Women take these drugs for good reasons,’’ said

But some pregnant women are so hesitant to take
any medications that even their doctor can’t
convince them otherwise. Vaccines are a case in
point: Claims that autism is linked to thimerosal, a
mercury-based preservative that is used in vials for
medications and vaccines, were debunked years
ago. Yet Wroble’s practice offers thimerosal-free flu

“The fear factor is so great,’’ she said.

When it comes to antidepressants, if the patient is
too scared to take them but Wroble believes they
would help, the two find a compromise. Wroble will
make sure the patient’s friends and family keep an
especially close watch, schedule more regular doctor’
s appointments, and set up counseling.

“We’ve had contracts that say, OK, we’re going to
see you more frequently, we’re going to set up this
support system,’’ Wroble said. “It is something that
we make prominent on their chart.’’

Then she’ll start the patient on antidepressants the
morning after delivery.
Police: Maryland
psychiatrist, son die in
Associated Press

WASHINGTON—A psychiatrist
specializing in women's health
shot and killed her 13-year-old
son at their home in suburban
Washington, and fatally shot
herself, police said Wednesday.

The bodies of Margaret Ferne
Jensvold, 54, and her son,
Benjamin Barnhard, were found
Tuesday afternoon in their
bedrooms. Police were called
after one of Jensvold's co-
workers reported being unable
to contact her for several days.
Jensvold was divorced and lived
with her son in the upper-
middle-class suburb of
Kensington, Md.

Each died of gunshot wounds,
police said late Wednesday,
and the state Medical
Examiner's office confirmed that
Benjamin was slain and
Jensvold committed suicide.
The deaths remain under

Jensvold was most recently
working with Kaiser Permanente
in Kensington, said her ex-
husband and Benjamin's father,
James Barnhard. He said he
had last spoken with Jensvold
several days ago to arrange a
time to pick up his only son from
her house.

"Ben was a very sweet and
loving child. I mean, he was just
one of the kindest and sweetest
kids a parent could ever wish to
have," Barnhard said. He said
his son had spent the last year
at a weight-loss program in
North Carolina and had shed
more than 100 pounds and
loved sailing and other water

He said he had no indication of
any problems between his son
and ex-wife.

"She was always nice to Ben.
Sometimes she could get a little
frustrated with him, but she was
always nice to
Ben," he added.

Robert Baum, Jensvold's
divorce attorney, said his client
was a devoted mother who
limited her medical practice to
care for her son, who had a
variety of health problems. She
also insisted that Benjamin's
father receive visitation rights,
even after a judicial master said
he was inclined to deny
visitation, Baum said.

"Countless people will miss her
warmth and compassion," Baum
said in a statement.

In 1990, Jensvold filed a federal
lawsuit against the National
Institutes of Mental Health,
where she had been a medical
staff fellow.

She alleged that a male
superior harassed her because
she was female and fired her in
1989 before she could
complete the third year of her
fellowship program. An eight-
person jury found in Jensvold's
favor, but that decision was
rendered moot in 1996 when a
judge held that she did not
have the right to a jury trial and
called her version of events an
"illusion" and "widely
exaggerated and skewed."

"She's an incredible person. I
know she struggled against
significant adversity, personally
and in her career, and
overcame a lot of hurdles to do
some wonderful research and
be a really good practitioner,"
said Lynne Bernabei, an
attorney who represented
Jensvold in her case.

"I think she had a great
compassion for women and
improving the lives of women
through good health research,
and she had a real passion for
that," Bernabei said. "It wasn't
just a 9-to-5 job for her. She
really cared."


Associated Press writer Ben
Nuckols contributed to this
San Diego
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Filing a complaint
San Diego Education Report
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Education Report
October 6, 2013
Patients who were harmed can join class action suit
against Kaiser Permanente

On October 2, 2013 a class action suit was filed in Alameda County,
California - alleging denial of timely and/or appropriate care.

Filed by Siegel, Lewitter, Malkani of Oakland, California
Contact Information: Latika Malkani
Phone Number: 510-452-5000
1939 Harrison Street, Suite 307
Oakland, California 94612

California Class Action Case RG13697775
Filing found here for your viewing:

[The complaint is interesting reading, discussing the investigation of the
California Department of Managed Health Care (DMHC).]

This suit consists of all current and former Kaiser members who have either
been denied access to mental health services, dissuaded from pursuing
mental health services, provided with delayed access to mental health
services and/or provided with inaccurate and confusing information from
Kaiser regarding mental health services available to them from October 2,
2009 to the present.

(Violations of Business and Professions Code, Section 17200 et seq.,
Violations of the Unruh Civil Rights Act, Breach of the Covenant of Good
Faith and Fair Dealing, Breach of Contract)

--Vickie Travis
Kaiser Permanente is for-profit and
its "mental health" program is a big part of achieving that goal
Kaiser Mental Health
Clinicians Authorize
November 20, 2014
By April Dembosky

A union of 2,500 mental
health clinicians at Kaiser
have voted to authorize a
strike, just one week after
Kaiser’s nurses went on
strike for two days.

In September, Kaiser
agreed to pay a $4-
million fine levied by
state regulators.
Department of Managed
Health Care found patients
were subject to excessively
long wait times to get a
therapy appointment, or were
shuttled into groups when
they wanted individual

Psychiatric social worker
Clement Papazian says
various fixes, like after-hours
appointments, still aren’t
meeting demand.

“Kaiser has attempted to
make some changes, but
they’re woefully inadequate
in really addressing the full
nature of the problem,” he
says. “Our mental health
workers are really fed up.”

These complaints are part of
a long, drawn-out contract
negotiation between Kaiser
and its psychologists and
therapists. Bargaining has
been dragging on for four
years with no settlement.
And the small, scrappy
National Union of
Healthcare Workers is
eager to make a name
for itself.

Union president Sal Rosselli
says the threat of a statewide
strike will strengthen the
union’s position when they
return to the table next month.

“We’ve had it,” Rosselli said.
“We’re drawing a line in the
sand. And we’ll be presenting
Kaiser with a final offer to
resolve this crisis.”

In a statement, Kaiser was
critical of the union’s strike

“After a long hiatus, NUHW
has now approached Kaiser
Permanente to resume
bargaining in Northern
California. But for the union
to threaten a strike before we
even meet, and to resort to
clichéd bargaining tactics,
makes us concerned about
the union’s intentions. We
hope the union will join us in
seeking solutions to the
challenges we face. But
whichever way the union
chooses to go, we are going
to continue to work hard on
our own to make progress.”

Kaiser says the union has
resisted several of its
proposals, like sending some
patients to non-Kaiser
therapists for treatment. It
says increasing access to
mental health care is a
challenge faced by the entire
health care industry, and
Kaiser is working hard to
make improvements.
Class Claims Kaiser Has Lax Suicide Care
Courthouse News
October 14, 2015       

LOS ANGELES (CN) - A class led by a woman who sought care while
suicidal claims Kaiser's mental health care does not measure up, in Los
Angeles County Superior Court.
The Department of Managed Health Services fined Kaiser $4 million in
September 2014 for alleged mental health care deficiencies, Courthouse
News Reported.
The lead plaintiff, identified in the lawsuit as S.F., now 50, says she was
diagnosed with Major Depressive Disorder over 15 years ago. Her
condition got worse and she became suicidal in 2010 when she learned
that her brother, who had molested her as a child, was going to become a
father, she says. Kaiser psychiatrists prescribed medication, but that did
not solve the problem, she says.
"S.F. was subsequently seen by three different Kaiser psychiatrists to
prescribe medicine to treat her Major Depressive Disorder. At least one of
these psychiatrists did not remember her on her return visit. S.F. felt that
no one at Kaiser was monitoring her mental health situation. Her
symptoms did not improve. She remained severely depressed and
suicidal," the complaint states.
Despite repeated requests for weekly therapy, and flouting the law, the
only options Kaiser offered were single-session appointments - followed by
two-to-three week waits for a follow-up appointment - or weekly group
therapy, according to the complaint.
S.F. says group therapy was not appropriate for her because she could
not discuss incest in that setting.
"Kaiser flatly and repeatedly refused to make an out-of-network referral,"
the complaint states.
"With no other choice to save her life, given her deep depression and
suicidal ideation, and the ineffectiveness of her monthly medication
appointments with Kaiser psychiatrists without accompanying therapy, S.F.
sought and began weekly individual therapy outside Kaiser," the complaint
Three years later, S.F. felt emotionally stable enough to handle her
business affairs and submitted claims for reimbursement to Kaiser,
according to the complaint. Kaiser denied her claims.
S.F. contends her therapy expenses should be reimbursed because her
Kaiser psychiatrist and a Kaiser Licensed Clinical Social Worker both knew
she was seeing outside therapists and recommended that she continue.
S.F. alleges unfair competition, Unruh Civil Rights Act violations, breach
of contract, breach of the implied covenant of good faith and fair dealing
and negligence. She seeks declaratory and injunctive relief, restitution,
compensatory, statutory and punitive damages, interest, attorneys' fees
and costs of suit. S.F. is represented by Christopher H. Knauf of Knauf
Associates in Santa Monica.
Psychologist Says Kaiser
April 28, 2016
Courthouse News

  OAKLAND, Calif. (CN) - Kaiser fired a
psychologist for speaking up about
alleged deficiencies in its mental health
care, he claims in Alameda County
Superior Court.

  Alex Wang, whose firing ignited a strike
across California protesting Kaiser's
mental health care, claims in the suit that
the HMO fired him for writing what they
called "political statements" on patients'

  Those statements included a note
indicating that Wang had encouraged a
patient to consider filing a complaint with
Kaiser's member services for appointment
delays, as well as a note that a patient
needed to be seen sooner than the
earliest available appointment.

  Wang says that
, after
California's Department of
Managed Health Care levied
a $4 million fine against
Kaiser for "serious
deficiencies" in providing
access to those services,
Kaiser began retaliating
against employees who had
been vocal advocates for
patient access
to mental health

  The fine came after the National Union
of Healthcare Workers -- of which Wang
was a representative -- filed a complaint
against Kaiser in 2011, claiming the HMO
regularly forced patients to endure illegally
lengthy waiting times for appointments.

  The union picketed Kaiser's California
facilities in May 2015 to protest Wang's

  Following the DMHC's fine, Wang said,
Kaiser began "closely monitoring,
scrutinizing and nitpicking" Wang's patient
charts, called him into periodic "coaching
sessions" and made other retaliatory
criticisms of his work.

  Kaiser eventually fired Wang, he says,
on the pretext of "unsatisfactory job

  The psychologist sued The Permanente
Medical Group on Wednesday for unlawful
termination and wrongful termination,
seeking injunctive relief, attorneys' fees
and special, general and punitive

  He is represented by Jonathan Siegel,
with Siegel Lewitter in Oakland, Calif.

  A Kaiser representative declined to
comment on the pending litigation.
Patient Says Kaiser Was
No Help at All
Courthouse News        
June 03, 2016

  SACRAMENTO (CN) — A Kaiser hospital
offered no help to a woman whose
mentally ill husband was its patient, and
refused to help her too after he nearly
strangled her to death, she claims in a
lawsuit against the healthcare giant.

  Marnie Lynch sued The Permanente
Medical Group, Kaiser Foundation Health
Plan, Kaiser Foundation Hospitals, and her
husband's therapist, Kiernan Michelle
Andrews, on May 31 in Superior Court.

  Lynch and her husband, Julius Lockett
Jr., were both Kaiser members, and her
husband was taking medication and being
treated by Andrews, Lynch says.

  In late January 2015, worried about her
husband's "insomnia, aggressive behavior,
loaded guns and dark thoughts," Lynch
called Kaiser to try to get him some more
help, but no one called back, she says.

  In early February 2015, he woke her
up at 2:30 a.m., "looking paranoid, with
sweat on his brow, and glassy eyes,"
and told her "that he was 'up all night
thinking about killing' her." She fled,
terrified, and called Kaiser three times
that morning, but no one called back,
she says in the complaint.

  On March 2, 2015, her husband nearly
killed her. "He brutally strangled her as he
held her body to the ground violently
shaking her and screaming, 'Do you want
to die?!! Do you want to die?!! Do you
want to die?!"

  He was arrested that night after Lynch
called 911. Then she called Kaiser again,
to report what had just happened, but "(a)
gain, Kaiser did not return Marnie's call."

  At 12:05 a.m. on March 3, she called
Kaiser again "to report that the police took
seven guns from the home, several of
which were loaded," she says in the

  She called Kaiser a third time at 8:46 a.
m. and left a 2-minute message, repeating
the story, "and explaining that she needed
  Kaiser finally returned her calls at 9:31 a.
m., but did not offer to help her, Lynch
says. She says the (unidentified)
counselor seemed more concerned about
whether Lockett had threatened his ex-
wife. Kaiser then issued a Tarasoff
warning to Lockett's ex-wife — a "duty to
warn" notice named for a California
Supreme Court ruling.
  To cap it off,
"as a patient of Kaiser
herself, Marnie went to Kaiser for
treatment of the emotional stress she
sustained, but Kaiser refused to treat
her. After hearing Marnie's harrowing
story, the counselor stated that Kaiser
does not 'do that type of counseling.'

No further care was rendered to Marnie by
Kaiser," according to the complaint.

  Lynch seeks lost income, and punitive
damages for negligence, negligent hiring
and training, and breach of duty of care to
her as a patient.

  She is represented by Shannon Mason
in Carmichael, whose assistant said Mason
was not able to comment on Thursday

  Kaiser did not respond to an e-mail
request for comment.
Lawsuit Filed By Family Of 9 Year
Old Stabbed To Death In Discovery

Pleasant Hill, CA
By Norcal Patch (Patch Staff)
June 25, 2016

County and the family of a 19-year-old man are
being sued by the parents of a boy the man
allegedly stabbed to death in Discovery Bay last
year for their actions leading up to the incident,
according to court records.

The lawsuit, which was filed in the U.S. District
Court of Northern California last month, alleges
county sheriff's deputies, health workers and the
suspect's family failed to properly respond to
warning signs before the 9-year-old boy was
killed on April 26, 2015.

Jordon Almgren was found suffering stab wounds
in a bed at a home in the 1900 block of Frost
Way by sheriff's deputies at 10 a.m. that day. He
was later pronounced dead at a hospital.

William Shultz, a friend of Jordon's older brother
who had spent the night in the home, was

arrested several hours later at a
Kaiser Permanente medical
center in Antioch on suspicion
of stabbing Almgren.

It was later revealed that Shultz
had undergone
a voluntary mental health
evaluation the day before
Almgren was killed.

Sheriff's Deputy Miguel Aguilera
was called to the Shultz home after
his mother reported she was
concerned about his violent
according to the federal lawsuit filed
on behalf of Almgren's parents.

Aguilera discovered a large Bear Grylls-brand
hunting knife in Shultz's knapsack that the teen
allegedly used later to kill Almgren, according to
the lawsuit.

The lawsuit alleges the knife was not
properly reported and that
he was allowed to keep it in his possession
after a county mental health clinician
evaluated and released him despite signs
he was mentally ill.

Attorney Michael Verna, who is representing the
Almgren family, is arguing in the federal lawsuit
that the boy was deprived of his civil rights
because of these actions.

"It's inexcusable for us to have a system where a
sheriff's (office) doesn't do its job and a county
health department doesn't do its job ... and the
result is that a 9-year-old is savagely stabbed to
death," he said.

The lawsuit aims to prove the named defendants
were "deliberately indifferent" to the danger
Shultz posed.

Sheriff's officials were not immediately available to
respond to the lawsuit.

The county has filed a motion to dismiss the
lawsuit on legal grounds of immunity. Verna said
an opposition to this motion was then filed in
response Wednesday.

In addition to the county, the lawsuit is also
naming Shultz and his parents as defendants.

It is alleged that the suspect's parents never
warned the victim's family of his violent
behavior despite the fact that he was going
to sleep at their house the same evening he
was evaluated for it.

The lawsuit is seeking unspecified financial
damages as well as the payment of funeral and
burial expenses.

-Bay City News, image via GoFundMe