Advocacy group says doctors over-prescribe psychiatric medication

Organization files suit, alleging psychiatrists followed drug marketing and ignored health

Posted: Friday, February 12, 2010

ANCHORAGE - More than two dozen Alaska child psychiatrists, agencies and companies have been sued by a mental health advocacy group that contends doctors over-prescribed medication for children and committed Medicaid fraud.

The lawsuit was filed last spring in U.S. District Court in Alaska by the Law Project for Psychiatric Rights but only unsealed last month, the Anchorage Daily News reported.

The group, led by Anchorage attorney Jim Gottstein, alleges the defendants followed drug company marketing to the point where there was reckless disregard for the health of their child patients. It also contends drugs were especially over-prescribed to children from low-income families and that state officials were complacent in the matter.

The doctors prescribed common psychiatric drugs for untested purposes, thereby committing Medicaid fraud, according to the lawsuit.

Some of the defendants said Gottstein's advocacy group doesn't understand the science behind their actions.

"I'm disappointed that one side of the information is reflected," said Yvonne Chase, president and CEO of Denali Family Services, which serves the mentally ill poor and is among the defendants. "We are all interested in the safety of our clients."

Gottstein's group was selective in its use of data, and that just as much research, if not more, says the opposite, Chase said.

Gottstein said his group wants to stop over-dispensing of medicines that affect the brain.

"All they (the psychiatrists) do is prescribe drugs," Gottstein told the newspaper. "It used to be that they actually tried to work with the children and find out what's going on with their lives. Now they are just pill pushers."

Dr. Ronald Martino, a Fairbanks psychiatrist and neurologist who is among the defendants, called it "a pretty extreme complaint."

"It really reflects an extreme and distorted view of the world. It's 50 years behind the times when they try to paint psychiatry as a specialty that is coercive in some way or using dangerous medications irresponsibly," he said.

Greg Wilkinson, spokesman for the state Department of Health and Social Services, which oversees several of the state agencies being sued, declined to comment.

Gottstein's organization contends that nine out of 10 children who see a child psychiatrist receive medication while fewer than 10 percent of the medications are approved by the Food and Drug Administration for psychiatric use in that population.

The lawsuit alleges the doctors prescribe the common psychiatric drugs for untested purposes, thereby committing Medicaid fraud because Medicaid is only supposed to reimburse costs for the drugs' designated purposes.

However, doctors can prescribe drugs as they see fit, and many have turned to "off-label" drugs to treat serious mental conditions in children, including schizophrenia and bipolar disorder.

Martino said it's well within the standard of care to prescribe drugs for reasons other than the labeled purposes. For example, many seizure medicines are useful in psychiatric disorders, he said.

State Medicaid pharmacist Chad Hope said the state doesn't know why a doctor prescribes a medicine because the diagnosis information is not included in the claims. The state pays whether the drug is on or off label because it doesn't know, he said.

The lawsuit was filed under the federal False Claims Act, which authorizes private parties to bring fraud actions on behalf of the federal government and keep a percentage if they win. Such cases are often under seal for several months to give federal investigators time to see if the government wants to join the lawsuit.

Alaska U.S. Attorney Karen Loeffler said the government has declined to intervene in this case.

The suit seeks $5,500 for every false prescription written, a potentially huge sum.

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