Alaska psychiatrists accused of wrongly medicating
FRAUD CLAIM: Doctors followed drug marketing recklessly, suit says.
By MEGAN HOLLAND
An Alaska mental health advocacy group that has spent years battling the pharmaceutical industry over medication is suing more than a dozen Alaska child psychiatrists, saying the doctors unnecessarily drugged children and committed Medicaid fraud.
The lawsuit, filed months ago in U.S. District Court in Alaska but only unsealed last month, is by the Law Project for Psychiatric Rights, led by Anchorage attorney Jim Gottstein. The organization filed as a whistleblower on behalf of the United States against the Alaska doctors and other defendants, including health service agencies, pharmacies, and state officials.
The case accused the defendants of following the drug companies' marketing to the point of deliberate ignorance or reckless disregard for the health of their patients when it comes to prescribing medications to kids. The suit says the drugs are especially overprescribed to youths from low-income families and that state officials are complacent in the alleged abuse.
But at least some of the people and organizations being sued say that Gottstein's advocacy group doesn't understand the science.
"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."
Chase said Gottstein's group was selective in its use of data to support its points. Just as much research, if not more, says the opposite, she said.
Gottstein says his group's goal is to stop over-dispensing psychotropics, medicines that affect the brain.
"All they (the psychiatrists) do is prescribe drugs," Gottstein said in an interview. "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 psychiatrist and neurologist in Fairbanks since 1980, is among the defendants. "It's a pretty extreme complaint. It really reflects an extreme and distorted view of the world," he said. "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."
Greg Wilkinson, spokesman for the Department of Health and Social Services, which oversees several of the state agencies being sued, declined to comment on ongoing litigation.
Several years ago, Gottstein took on drug giant Eli Lilly over its best-selling Zyprexa, approved for treatment of schizophrenia. He leaked documents to The New York Times, saying the drug company promoted unapproved uses of the medicine. That has led to lawsuits nationwide against the drug manufacturer.
The psychiatric rights project says nine of 10 kids seeing a child psychiatrist receive medication while fewer than 10 percent of the medications are FDA-approved for psychiatric use in that population.
According to a study late last year from Rutgers and Columbia universities, children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. It's this population that the lawsuit is most concerned with.
Psychotropic pharmaceuticals have faced heightened scrutiny in recent years. The Food and Drug Administration is researching children's use of the drugs and possible side effects.
The lawsuit asserts that the doctors prescribe the common psychiatric drugs for untested purposes, thereby committing Medicaid fraud because Medicaid is only to reimburse costs for the designated purposes of the drugs. At least half of psychotropic drug prescriptions to children and adolescents submitted to Medicaid are not for medically accepted indications and therefore fraudulent, it says. But 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.
"They are relying on the drug companies -- that show up with cookies and brownies and give them lunch and put on and pay for continuing medical education," Gottstein said of why the doctors prescribe the drugs they do.
But doctors like Martino say it's well within the standard of care to prescribe drugs for reasons other than the stated 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 -- 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. Gottstein says that just means Alaska Medicaid is not complying with the law.
Once a medication is approved for the public, the drug company doesn't have to bring it to the FDA again for approval for another purpose, which Martino says is a very expensive process. The doctors rely on research after that to tell them what the drugs are good for, he said.
The case was filed under the federal False Claims Act, a Civil-War era law originally designed to enlist citizens in the fight against war profiteers. The law authorizes private parties to bring fraud actions on behalf of the federal government and keep a percentage if they win. Such suits are often under seal for several months -- the defendants sometimes don't know they are being sued -- to give federal investigators time to see if the government wants to join the suit. 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. For three months, from April 2007 until the end of June 2007, the number of children's Medicare prescription claims for psychotropic drugs was just over 12,450, according to a Freedom of Information Act request to the state Medicaid office posted on the psychiatric rights organization's Web site.Find Megan Holland online at adn.com/contact/mholland or call 257-4343.
judgemenot wrote on 02/11/2010 10:13:03 PM:
I'm glad Jimmy Gottstein is doing this.
Has anyone ever seen the movie, " One Flew Over the Cuckoos Nest? " In Alaska's case, it's, One Can't Fly Over Any Nest.
jolarey wrote on 02/11/2010 05:07:22 PM:
Hurray for Gottstein.. better late than never. I hope he wins, and I hope the Anchorage school district is one of the defendants. Their only solution to noramally active kids is stuffing them with drugs, and they're not happy unless they have a school room full of zombies staring at the wall.
beverlytran wrote on 02/11/2010 02:42:30 PM:
The overmedication of children receiving SCHIP or Medicaid, in poverty or foster care, respectively, has been verified in various federal and state investigative reports. States overmedicate children to chemically restrain behavior and to justify other forms of aberrant billing in child welfare, as it is the path of "revenue-maximizing schemes".
I find it disheartening that there are those who would rather have children suffer and die from overmedication of psych meds and support Medicaid fraud in child welfare than to admit the practice is not in the best interests of children.
An Original Source
To learn more about Medicaid fraud in child welfare:
For daily information on the child welfare industry: www.legallykidnapped.com
AKFlyFishn wrote on 02/11/2010 01:51:21 PM:
After reading these bleeding heart posts, I feel the need for another Prozac! Thanks!
isis3240 wrote on 02/11/2010 01:31:01 PM:
Medicaid is Federaly run medical insurance for low income people.
Federally it is not mandated that a patient seeing a therapist see a psychiatrist to be eligiable for treatment...but the State of Alaska REQUIRES ALL patients on medicaid or Denali Kid Care to see a psychiatrist at least once a year to be eligiable to just talk to a couselor once a week. Medicaid and Denali Kid Care have gone to a formulary plan. I know for a fact that ALL rescue inhalers (asthma meds) are no longer covered unless the prescribing Dr. answers certain questions as to medical nesscity. ADHD and antidepressants are automatically covered with no questions
portagelakesguy wrote on 02/11/2010 12:01:52 PM:
Schools have been pushing parents and their doctors to prescribe Ritalin for years. It is not needed in may of these children. Yes, America's answer to every problem we have in life is, slap a disease and or condition with a name to our problem and prescribe some medicine for it. The truth is, every medicine has a side effect and or is never a long term solution to any problem. If the disease is not going to kill you if your not taking the prescribed medicine, then get off it as soon as you can.
AKFlyFishn wrote on 02/11/2010 11:45:12 AM:
My boss just yelled at me, where's my prozac?
Wolfie wrote on 02/11/2010 11:41:59 AM:
I truly believe as a Nation we are taking too many drugs. The Easy Fix.
"Oh My! I just sneezed let me run to the doctor and take a pill".
Perhaps Some of theses Children did benefit from these drugs, but I Hope for more preventative Care for our nation as a whole.
And much less propaganda feeding from the drug companies.
lnhbowlus wrote on 02/11/2010 11:31:16 AM:
Lets not forget the role the school system plays in drugging children. School districts get more federal money for children who have been labeled with any disorder and require such medication at school. It is easy for the nurse or teacher to suggest a child has ADD, ADHD, or a whole spectrum to "problems" to a parent who is frazzled, working more than one job, and doesn't have time to wear a very active child out physically. Parent then has an excuse to medicate the child. School wins, psych doc wins, drug companies win, parent has a zombie compliant child, and the only losers are the children and taxpayers. Check stats on how many of the adolescents who went postal in schools were on psychotropic drugs... Back in the day when kids had (eek) chores and were physically active, there were no school massacres.
babyavalon wrote on 02/11/2010 11:20:40 AM:
This is merely a claim, by lawyers posing as health "advocates", and accusing psychiatrists of Medicaid Fraud. A misguided, ill informed, witch hunt that will require each doctor around 80,000 to defend for a case that will ultimately go nowhere.
For attorneys, these are bread-and-butter cases. The doctors will get an attorney assigned from their malpractice insurance carriers, who will "defend" and drag this out over a year and end in a dropped case. The malpractice costs will rise and so will health care. This is exactly why attorneys (and our fearful leader Obama) are against tort reform. ATTORNEYS GET A VERY LARGE CHUNK OF EACH HEALTHCARE DOLLAR.
HEALTH CARE WITHOUT TORT REFORM: this is where we are headed folks. More witch-hunt law suits, more paper work for doctors to justify their diagnosises, and more paper work to justify their remedies and thereby driving the doctors to have less time with patients at higher costs. All for the growing entitlement class: Medicaid.
cyberdoc wrote on 02/11/2010 11:17:26 AM:
Sorry bleeding hearts but this lawsuit won't go anywhere or solve anything. Gottstein is really stretching if he thinks this will have the payday the Zyprexa case did. The kids on these treatments really need the medicines to keep from hurting themselves or someone else and counseling is definitely not enough and way too expensive and not adequately available. These cases are not little Johnny and Janes taking Ritalin so they can be calm at school, this is a whole different scenario where Johnny and Jane need medication so they don't cut off their fingers, skin the neighbors dog or burn down their apartment building.
AKFlyFishn wrote on 02/11/2010 11:13:28 AM:
Itís about time! The idea that the psychological professionals around the nation are acting in our best interest is a crock! This nation (compared to Europe) is over medicated, especially when it comes to antipsychotic treatment. Feeling stressed, take a pill. Feeling overwhelmed, take a pill. Not getting along with your boss, take a pillÖÖ. Iím sorry but Tom Cruise had a point, we are over medicated, and the pharmaceutical industry and prescribers are at the rout of the problem!
shortsnort wrote on 02/11/2010 11:12:57 AM:
I have Tardive Dyskinesia due to doctors prescribing me medications, when I was young. TD is a very painful disease, which worsens each year and will continue making my muscles, twitch uncontrollably. These doctors never told me these medications would cause irreputible damage to my body, including my heart, which is also a muscle. Throughout the years, every tooth would end up broken, eventually every tooth was removed and I have to wear dentures, all caused from the twitching of my jaws. Yet, the doctors knowingly, gave me the meds that did this, without letting me know the side effects. Someone needs to be held accountable for prescribing medications that cause side effects, including death, to patients, at least Mr. Gottstein is doing something about these pharmicutical companies, doctors and clinics, he has my support!
abusenobugsinak wrote on 02/11/2010 11:09:39 AM:
I should add that I have a child who has been treated by one of the doctors being sued. The treatment has been extensive and highly professional. And I remain convinced that pharmaceutical intervention is the one thing that prevented a suicide.
Does Jim Gottstein care about this? Absolutely not. He would happily stand aside as my child pulled the trigger, as long as he could sue someone afterward.
nobugsinak wrote on 02/11/2010 11:04:41 AM:
Jim Gottstein is the clear and obvious crook here. Nowhere in the article does it state that he has filed this case on behalf of any parents. He has filed it under an archaic, Civil War-era law on "behalf" of the United states, and as the article stares, "The law authorizes private parties to bring fraud actions on behalf of the federal government and keep a percentage if they win."
Anyone who thinks this man cares about anything making big bucks is a fool. This is unbridled greed at its absolute worst. This scumbag lawyer is besmirching the reputations of doctors in an effort at lining his own pockets.
Ptery wrote on 02/11/2010 10:57:53 AM:
Hurrah for brave Gottstein. To all who wonder what he gets out of it. Well, the last time he outed the pharmaceutical company on their hidden information that Zyprexa increases risk for diabetes, he got harassed extensively by their lawyers wanting to sue him. For his views, he has had to go against the current all his professional life and now, he is still acting like David with pharmaceuticals has the giants they are.
I do have empathy for parents and the teachers who have to try and govern the classroom when there really is too little available. I recommend this book to start creating something else :="Schools That Learn" by Peter Senge. The other book, that I recommend, to help people understand psychiatry today is "Crazy Like Us" by Ethan Watters. As for the psychiatrists themselves, I think they have gone through a Cult like training and it has been called a proffession. Some of them survive their training and others remain detached from the suffering their treatments cause.
fullaccess wrote on 02/11/2010 10:39:54 AM:
My son was an Honor Student and was a patient of Martino, now my son lives in an Assisted Living Home.
moose907 wrote on 02/11/2010 10:18:26 AM:
Sadly this is a true story. My son see's a very prominent psychiatrist at providence we go in he ask him how he's doing and feeling ask dad if the med's are working ok writes a prescription and tell's us to make a fallow up out the door. Never a one on one with the kid or anything of that nature. He doesn't go there anymore.
liciabelle wrote on 02/11/2010 10:10:50 AM:
Thank you Mr. Gottstein! I'm glad to hear someone is taking a stand against the abuse of psychiatric drugs. I have watched too many friends become dependent on prescription drugs because they don't know any different. Their parents and doctors drugged them from a very early age and they grew to believe it was a normal part of life. Their dysfunctional, drug dependant, adult lives proves that there is nothing normal about it.
Whizard wrote on 02/11/2010 09:39:05 AM:
What about the abuse of unruly schoolkids...calling it ADD, and drugging them to make it easier for the teachers. Shheesh! It is my understanding that those kids, now having been "prescribed" psychotropic drugs, will, as adults be limited in some job choices, their ability to own a gun, etc. Also, the Alaska Native Hospital is off the radar although they have been doing this for years. Ya gotta control them kids ya know!
steveconn wrote on 02/11/2010 09:33:13 AM:
Gottstein performs a public service for Alaskans with this law suit.
akchic wrote on 02/11/2010 08:19:24 AM:
I've had two children on ADHD medications. We (the psychiatrist and I) really didn't want to go the medication route, but when you have two children who won't fall asleep for 2-3 days at a time, it is necessary. My kids were on medication for 3 years while we tried different ways to retrain their bodies to go to sleep every night, behavior techniques for the day (they both are ADHD - and had a neuropsychologist back up the diagnosis). I would love to have my kids off medications, but the fact remains that if they aren't, I would have kids that won't sleep for days.
yankeefan09 wrote on 02/11/2010 08:14:06 AM:
There is big money in drug medication prescriptions, and this abuse has been rampant for a long time. The problem is now we are seeing the long term affects of psychotropic drugs on the individuals and it's pretty ugly! Ritalin for example has been called, "kiddie cocaine" and some of the affects of long term usage are terrible. I have dealt with some of these so called psychiatrists in my former jobs, and believe me they need medications themselves! You go Gottstein and keep an eye on these pill pushers!
Polly1 wrote on 02/11/2010 07:16:35 AM:
I agree with Mr. Gottstein...children shouldn't be prescribed medications that mess with the 3 trillion neurotransmitters in their developing brain. It is too abstract and hit and miss "science". But, shouldn't pharma be sued for their false marketing instead?
shana wrote on 02/11/2010 06:20:43 AM:
akbnd...a psychologist has not had as much education as a psychiatrist which
has to become a doctor to prescribe drugs. Psychologist are trained to talk and
retrain, psychiatrist to take care of medical problems...
shana wrote on 02/11/2010 06:18:35 AM:
Its not just the psychologist, medicaid has been frauded by doctors too, had a major surgery, left me "life long dependent on medications and doctors while I was on state funds to get by. I can remember the doctor saying. "This surgery can wait till she is insured by real insurance, but lets go ahead and do it." At the time I did not realize what that was going to entail for my life, thought docs knew best, they lied to me.
akbmd wrote on 02/11/2010 05:55:00 AM:
A psychiatrist and psychologist is not the same thing. A psychologist is the person that listens to your problems for an hour, a psychiatrist is the one that adjusts your medications based on your issues. In the comments, it seems like some people are mixing them up. Our mental health options in AK just aren't good, that's the bottom line.
lhadley wrote on 02/11/2010 05:45:52 AM:
Medication helps our children with their mental health issues but the Psychiatrist who prescribes spends almost no time getting to know the child nor do they care.
eclectic1 wrote on 02/11/2010 05:36:58 AM:
Gottstein says his group's goal is ....................? Sounds a lot like lawyers trying to make their bucks off the pharmaceutical companies and doctors because both have deep pockets.
Who is Gottstein? How is he profiting? Who is his group? This is a prime example of why tort reform needs to be a part of any health care reform. What information does Gottstein have that proves his claim vs. the help to people with mental problems? This lawsuit really does have the stink of leech-lawyers suggested.
my2cents1 wrote on 02/11/2010 05:35:45 AM:
90 percent of the drugs given out do more harm than good.
the psychobabble from the big pharmaceutical industry who push their drugs onto everyone for every reason is a criminal enterprise that needs to be shut down.
walterk wrote on 02/11/2010 05:10:04 AM:
There are a lot of good psychiatrists and we need to remember that the few who are being investigated or charged have yet to be found guilty of any crime. There are a lot of meds are on the market and a lot of them help people.
moonlitnite wrote on 02/11/2010 03:57:26 AM:
It must be difficult to get information on this case when all the individuals have privacy. It is interesting, and it's good that somebody is paying attention to medicaid prescriptions. I have been around pharmaceutical sales reps before, they make a lot of money and they love to push their drugs.
Ak2468 wrote on 02/11/2010 03:53:23 AM:
Itís been long overdue to hold these quacks ( child psychiatrists) accountable. Alaska is full of unscrupulous psychiatrists that have the main goal of making money and not helping people. They are protected from their wrongdoings because most people do not have the money to sue them for malpractice. I hope all the defendant's names get published and exposed. I am sure the doctors would label me crazy for making such a wish.
kasandra wrote on 02/11/2010 03:22:12 AM:
emerymcupples wrote on 02/11/2010 03:07:18 AM:
THANKS FOR YOUR UNSELFISH EFFORT TO RIGHT THIS WRONG. YOU HAVE DEVOTED
YEARS TO THIS EFFORT.
WORKING WITH THE YOUTH AND ADULTS ON MENTAL HEALTH ISSUES HAS TO BE A LABOR OF LOVE AND DEEP CARING. ALASKANS APPRECIATE YOUR HELP.
ButterflyBaby wrote on 02/11/2010 00:56:01 AM:
Thats exactly whats wrong with this country.
People are willing to do anything to make a buck. Even at the expense of others health.
Thats why this country is having financial difficulties.
Everything is sent over seas or made over seas to save a penny.
Most things are made in China or else where, not that I have anything against Chinese people.
Read the label and do your part and have it proudly Made in America.
emerymcupples wrote on 02/11/2010 00:27:11 AM:
Thank you, Mr. JIM GOTTST-----------------------------------------------------------------------------------
bleepbloop wrote on 02/10/2010 11:52:21 PM:
As a visitor to many Psychiatrists when I was a going through leukemia, I believe this is slightly ridiculous.
Everyone is making it sound like these doctors took a handful of pills and shoved them down the kid's throat. They don't have to take the drugs. The parents don't have to make them take the drugs. Whenever I went to my primary Psychiatrist he would set me up for an introduction appointment to evaluate my well being and set a course of action. During my next appointment, he would suggest courses of actions: Counseling, medication, both? My parents thought the combination of taking the medication and counseling would be best. See how my parents made the decision to have me take the medication? And I'm glad they did. Of course I'm off of them by now but during that time in my life I greatly appreciated it along with my counseling.
No one evoked the parent's ability to make decisions regarding their child. It's just another lawsuit to make a quick buck.
DannyHaszard wrote on 02/10/2010 11:29:20 PM:
Eli Lilly has made $40 billion on $10 a pill Zyprexa and it was way oversold and caused diabetes and in some cases sudden death.
Zyprexa was pushed by Lilly Drug Reps.
They called it the "Five at Five" (5 mg at 5 pm to keep nursing home patients subdued and sleepy) and "VIVA ZYPREXA" (Zyprexa for everybody) campaigns to off label market Eli Lilly Zyprexa as a fix for unapproved usage.
yksin wrote on 02/10/2010 11:19:23 PM:
My partner's nephew came to us at age 9 (he's now 22) from a history of extreme abuse & neglect followed by 1-1/2 years in care of a county in Missouri which put him on a number of drugs in succession including Ritalin, Dexedrine, Thorazine (an antipyschotic), & Imipramine (a tricylic antidepressenant). Did the psychiatrists who prescribed these drugs have the faintest idea what they were doing, or were they just making guesses? The latter, I'm quite sure. We gradually withdrew him from the Imimpramine over several months under the supervision of psychiatrists that we had to have him see just in order not to lose custody ourselves. Typical psychiatric meeting even w/ the state's top child psychiatrist: 15 minutes. Right, that'll tell you a lot about the kid's life, won't it. Medicaid? yes. But b/c we knew it was wrong, he's been drug free since age 10, & had grown into a wonderful young man.
Go Jim Gottstein!
shea5675 wrote on 02/10/2010 11:13:12 PM:
I am looking
kynlil wrote on 02/10/2010 11:12:57 PM:
and how does a person find out the names of the doctor's being who are doing this so you can see if your child's doctors name is on this list
kynlil wrote on 02/10/2010 11:11:47 PM:
If a person has a drug that was prescribed by a doctor and your not sure if your child should really have it .. does anyone have a name of a good child psychiatrist who is good that can give you a second opinion????
shea5675 wrote on 02/10/2010 11:11:41 PM:
I would suggest a good lawyer jumps up. And starts calling parents
arctic_honey wrote on 02/10/2010 10:46:39 PM:
amen! get rid of all those drugs and start getting to the root of the problems, most likely the family dynamics by which these children are subjected to.
truthgazer wrote on 02/10/2010 10:40:10 PM:
The amount of prescription drug use for children is outrageious. If a child is too active, etc. they are too easily prescribed drugs. There should be many steps that are tried prior to drug use. Some children are so zoned out, they hardly know what is going on. This has to be one of the most abusive events that has occurred in the past 15-20 years in our culture effecting the development of a child. There is plenty of blame to go around, but, face it, everyone but the child benefits with this diagnosis; from the teacher wanting a more manageable classroom to the drug companies that push these drugs without regard to their lifetime consequence. For many, this drug use is a gateway to illegal drugs as they grow older.
askatude wrote on 02/10/2010 10:35:35 PM:
"Of course child psychiatrists will get sued. They shouldn't let children be psychiatrists". (to get that post out of the way and save someone a minute)
Psychiatry was once a legitimate branch of medicine, but now it is more a subspecialty of marketing. Psychiatrists are pharma company reps.
dkpine Jim Gottstein is an honest type.
dkpine wrote on 02/10/2010 09:35:45 PM:
are the families of these children going to get this money if they win? since they were the one effected by these drugs.