MANAGED CARE June 2000. ©2000 MediMedia USA
Bowing to public condemnation, Kaiser Permanente will no longer require psychiatrists to write prescriptions for some patients they have not seen. The not-for-profit organization says its psychiatrists now will examine all patients before a prescription is written.
A San Diego psychiatrist filed suit against Kaiser, claiming it fired him after he refused to prescribe medication without having examined the patient. Under a longstanding Kaiser policy, patients received an initial workup by a psychologist or clinical social worker, who could recommend that a prescription be written.
According to the claim, if a psychiatrist then reviewed the case and made a diagnosis of mild depression or anxiety, that doctor would be required to write a prescription, if recommended by the initial therapist. The patient could start medication therapy and would be seen by a psychiatrist for a follow-up visit.
Kaiser says that nonmedical personnel do not make specific prescribing recommendations, and that its policy was “team based” and was intended to avoid duplicate examinations. California law, however, requires that physicians physically examine patients before prescribing for them.
The lawsuit brought attention to Kaiser’s practice and invited a state investigation. The now-abandoned policy was criticized by the American Psychiatric Association, whose code of ethics requires physicians to conduct a medical exam before prescribing drugs.
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