Three potentially landmark lawsuits challenging managed care practices and discrimination against the mentally ill will be the first recipients of contributions from APA's million-dollar litigation fund.

Announced by APA President Harold Eist, M.D., on March 17, the three-pronged assault is designed to throw up a roadblock in the path of insurers and employers whose actions compromise the ability of psychiatrists to deliver optimal care to their patients.

"Our members have demanded that we take strong legal action to forcefully defend against any organization that denies patients access to high-quality and medically necessary psychiatric care," Eist emphasized.

In the first of the suits, APA has agreed to join as a plaintiff and offer financial support in a huge class-action suit against the country's nine largest managed behavioral health care companies. The legal action charges that these firms have violated federal antitrust laws by conspiring to "fix, maintain, and stabilize the professional fees" of all of the psychiatrists, psychologists, and social workers in the U.S. who treat patients whose care is reviewed by any of the nine managed care firms. New York attorney Joseph Sahid, who represents the plaintiffs, noted that if successful, the suit could cost the companies more than a billion dollars in damages, injunctive relief, and attorneys' fees (Psychiatric News, February 7).

The companies being sued are CMG Health, FHC Options, Foundation Health PsychCare Services, Green Spring Health Services, Human Affairs International, Merit Behavioral Care Corp., MCC Behavioral Care, United Behavioral Systems, and Value Behavioral Health.

Another legal challenge that is related to managed care and will benefit from APA's litigation fund is a soon-to-be-filed class-action suit on behalf of patients insured by Blue Cross affiliates whose mental health or substance abuse treatment is managed by Green Spring Health Services Inc.

The suit charges that these patients routinely endure denials of insurance coverage for their care based on medical necessity criteria that Green Spring Health Services refuses to disclose, because, the suit alleges, the company is using stricter standards for approving treatment than those called for in its agreements with the Blue Cross companies.

Not only will this suit attempt to redress violations of patients' rights under their policies with Blue Cross, it "will endeavor to recover damages sustained by all patients who have unfairly been denied coverage," said Eist, who is also chair of the committee that oversees the APA litigation fund.

The law firm Carnot, Zapor, and Klassen, based in Rockville, Md., is representing the plaintiffs in their suit and wants to talk with physicians who have treated patients who are insured by Blue Cross and have had recommended psychiatric care denied by the insurer in the last five years.

The third suit was brought by a worker who is disabled by chronic depression. He is suing his employer for providing a disability insurance policy that offers more restrictive benefits for disabilities attributable to mental illness than it does for ones caused by a physical disorder (see story on page 1).

The suit charges that such discriminatory benefits policies violate the Americans with Disabilities Act (ADA), which prohibits employers from discriminating against workers based on a particular disorder or type of disability and specifically bars them from setting different standards for employees with mental illnesses. The APA Trustees' vote to join this suit allies them with the New York State Psychiatric Association, which was instrumental in developing the legal challenge and has pledged financial resources to support it.

(Psychiatric News, April 4, 1997)