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 (right )
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.