I am writing in reaction to the article "Kaiser’s Prescribing Policy Leads to Lawsuit, Ethics Concerns" in the May 5 issue. The Kaiser practices described foretell how and why psychologists will get prescribing privileges.

Clearly health plan administrators want psychologist prescribing because they believe that it will cut their costs. They cut costs now by understating their psychiatric departments.

At the same time, psychiatrists who agree to practice in this mode de facto give psychologists and other nonphysician mental health workers prescribing privileges. If a psychiatrist believes that he or she cannot do a better diagnostic interview than an M.F.C.C., L.C.S.W., or psychologist, then maybe that psychiatrist should not be prescribing, but he or she should not delegate that responsibility to a non-M.D.

It is this very type of practice that gives legal and legislative ammunition to the proponents of psychologist prescribing. A few psychiatrists in their offices can undo organized medicine’s tremendous lobbying efforts with legislators.

Each of us needs to think about the impact our actions will have on our profession and on the future of our patients.

Michael V. DeLollis, M.D.

Reedley, Calif.

On the front page of the May 5 issue, there is an extensive article describing "Kaiser’s Prescribing Policy. . ." and how it has led to a lawsuit. This article contains among other assertions that psychiatrists who apply for work with Kaiser are aware of the Kaiser policy and apparently agree to abide by it. The article did not indicate (1) whether psychiatrists, in fact, did prescribe without examination (a basis for malpractice suit in California), (2) why a psychiatrist would work for Kaiser under those conditions, and (3) who is to blame for compliance, Kaiser or the psychiatrists?

Malvin Braverman, M.D.

Pacific Palisades, Calif.