APA News Release
American Psychiatric Association
1400 K St., NW
Washington, DC 20005
FOR IMMEDIATE RELEASE March 17, 1997
Contact: Gus Cervini; (202) 682-6142; [email protected]
APA ANNOUNCES LEGAL ACTIONS TO PROTECT PATIENTS
The American Psychiatric Association is going to court to protect the right of patients to receive optimal care for their mental illnesses, APA President Harold I. Eist, M.D., announced today. In a three-pronged attack, the APA is:
o Challenging managed care profiteering by joining as a plaintiff in an antitrust lawsuit filed in New York State on behalf of all psychiatrists, psychologists, and social workers in the U.S. against nine of the nation's largest mental health carve-out organizations. (U.S. District Court for the Southern District of New York, Docket #96 CIV 7798)
o Seeking to protect patients from discrimination under the Americans With Disabilities Act by joining with the New York State Psychiatric Association in providing financial support in a suit against an employer that provided fewer benefits for people disabled by mental disabilities than with other disabilities. (Leonard F. v. Israel Discount Bank)
o Opposing arbitrary and capricious denials of medically necessary care through financial support of class action lawsuits against Blue Cross Companies which use Green Spring Health Services to review the medical necessity of psychiatric and substance abuse treatment decisions.
The actions were approved by the APA Trustees Friday March 14, 1997. They are part of the Association's proactive litigation strategy and are supported through a special fund created in 1995. "Our members have demanded that we take strong legal action to forcefully defend against any organization which denies patients access to high quality and medically necessary psychiatric care," said Dr. Eist. "Today, in accord with our time-honored responsibility as patient advocates, we are launching the first in a series of actions against abuses of our patients' right to essential quality care," he added.
Details:
New York Antitrust -- APA has joined as a plaintiff in a class action suit against CMG Health, FHC Options, Foundation Health PsychCare Services, Green Springs Health Services, Human Affairs International, Merit Behavioral Care Corp., MCC Behavioral Care, United Behavioral Systems, and Value Behavioral Health. Plaintiffs charge the companies with a series of antitrust violations in which "the defendants and their co-conspirators determined whether and under what terms" providers of mental illness care could sell their services throughout the country, by working together to "fix, maintain, and stabilize the professional fees" of psychiatrists, psychologists, and social workers. If successful, the suit seeking treble damages, could cost the defendant companies billions of dollars. Dr. Eist, who considers the suit meritorious, said "This suit attacks entrepreneurial greed which denies patient access to treatment as profit makers seek to line their pockets with money which should be going to patient care. Managed care companies that engage in such antitrust breaches deserve to be prosecuted to the fullest extent of the law." New York attorney Joseph R. Sahid represents the plaintiffs who include all psychiatrists, psychologists, and social workers in the U.S. who regularly treat patients.
Blue Cross/Green Spring -- The APA will provide financial support to a number of class action suits to be filed soon by the Rockville, Maryland, law firm of Carnot, Zapor & Klassen, P.C. on behalf of patients denied coverage by Blue Cross companies for treatment which has been prescribed by their physicians. These lawsuits will seek to end the practice of least 21 Blue Cross companies which deny coverage for psychiatric and substance abuse care based on Green Spring Health Services' deliberately undisclosed criteria for medical necessity which are more restrictive and impose more conditions than the criteria described in the patients' Blue Cross policies.
"The APA believes this practice violates patients rights under the policies purchased, and has prevented and will continue to prevent many from receiving the care their physicians believe is necessary and to which they are entitled under their policies," said Dr. Eist.
"Not only will these lawsuits seek to enforce the criteria of the policies, they will endeavor to recover damages sustained by all patients who have been unfairly denied coverage," he added. The amount of the APA financial support to these lawsuits has not yet been determined.
Attorneys for the suits have asked physicians whose patients have been denied coverage for psychiatric or substance abuse treatment by a Blue Cross company in the last five years to contact Edward J. Carnot, Esquire, 1-800-331-1230.
Americans With Disabilities Suit -- The APA is joining with the New York State Psychiatric Association in providing financial support to this suit brought against the Israel Discount Bank of New York and the Metroplitan Life Insurance Compnany by Leonard F., an employee who had gone on disability leave from the bank following a mental breakdown with chronic depression. He was deemed eligible for disability due to "mental/nervous disorders" for two years. There was no similar limitation on disability coverage for other medical disability.
Plaintiffs hold that the ADA prohibits employers from discriminating in any manner against individuals with any mental or physical disability, including the use of discriminatory health and disability insurance benefits. The bank, maintaining that the ADA applies only to disabled people who nevertheless can perform their jobs, asked that the suit be dismissed. The suit was dismissed in November 1995 by the U.S. District Court for the Southern District of New York and reinstated by the U.S. Court of Appeals for the Second Circuit in June, 1996. A second attempt to dismiss was denied. The trial is expected in the fall of 1997. Leonard F. is represented by the law firm of Stein & Schonfeld of Garden City, New York, and the New York Lawyers for the Public Interest in New York City.
In announcing the APA Trustees' decision to support the case, Dr. Eist said, "By supporting this action, we are reaching out to protect our most vulnerable patients from greedy employers and insurance companies who would discriminate against employees disabled by mental illness. The APA cannot tolerate, nor should the nation tolerate, discrimination in disability policies against people with mental illnesses." # # #
For further information about these suits, media and members of the public should contact the attorneys for each:
New York Antitrust: Joseph R. Sahid, Esq., New York, NY, (212) 308-5930; Blue Cross/Green Spring: Edward J. Carnot, Esq., Carnot, Zapor & Klassen,
Rockville, MD (800) 331-1230; Americans With Disabilities Suit: Seth Stein, Esq., Stein & Schonfeld, Garden City, NY
(516) 542-0088.
# # #
The American Psychiatric Association, founded in 1844, is the nation's oldest medical specialty society, whose 42,000 physician members specialize in the diagnosis and treatment of mental and emotional illnesses and substance use disorders.
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