Kaiser on the Examination Table

Kaiser Permanente’s reversal Tuesday of a policy that required its psychiatrists to prescribe drugs to patients without examining them should not end the investigation that state regulators launched last month.

The first task of the regulating agency, the Department of Corporations, should be to determine the scope and gravity of the practice, which came to light in a lawsuit filed last month by former Kaiser psychiatrist Thomas S. Jensen. Was requiring doctors to write prescriptions based on the observations and recommendations of staff social workers “unique” to San Diego, as Kaiser asserts, or more widespread, as consumer advocates charged in a letter sent to state officials Wednesday? Were the psychiatrists prescribing only low “starter doses” of newer antidepressant drugs with relatively few side effects, as Kaiser asserts? Or, as Jensen insists, were they engaged in something more perilous: prescribing powerful psychotropic medications and providing drug refills for up to three years without a follow-up doctor’s examination?

The biggest question of all, however, is why it took a public lawsuit to get state regulators to investigate a practice that Kaiser engaged in for 20 years in apparent violation of both state law and psychiatric ethics codes. All HMOs remain under intense pressure to cut costs, and regulators need to be out there digging for problems if patients are to be protected.

On July 1, the Department of Corporations will be replaced by another oversight authority, the newly created, more specialized Department of Managed Care. Legislators have promised to give the new department more extensive resources. As the problems at California’s biggest HMO demonstrate, regulators need them.