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APA is considering a class-action complaint through its Litigation Fund on behalf of psychiatrists against Green Spring Health Services Inc., which is based in Columbia, Md.
The case involves the legal implications of Green Spring's decision to target certain high-volume health care providers in Maine for proposed site visits and full-chart reviews of patient records, according to Harold Eist, M.D., chair of the Litigation Fund and former APA president.
Collin Pope, M.D., president of the Maine Psychiatric Association (MPA), told Psychiatric News, "The MPA Executive Council voted unanimously to support APA in this legal process. Standing up for our patients' privacy, confidentiality, and quality of care must be our concern as a profession and not just as Maine physicians."
Eist told Psychiatric News, "The lawsuit sends a clear statement to Green Spring that APA and MPA will not tolerate invasions of patient privacy and any situation that deviates from our ethical requirements of full informed consent."
At press time, case attorney Edward Carnot of Carnot, Zapor, and Klassen in Rockville, Md., said that a class-action complaint was to be filed in late July in the Superior Court of Portland, Maine, unless Green Spring agreed to APA's proposed remedy.
Since January Green Spring has requested that five psychiatrists in Maine allow site visits to inspect their offices and to provide complete copies of three patients' medical records (Psychiatric News, June 5). APA member and plaintiff Jerome Collins, M.D., has repeatedly requested that Green Spring impose a moratorium on implementing its quality assurance program until he and other providers, MPA, and APA can fully investigate the relevant legal and ethical issues, according to a draft class-action complaint.
The company, which is now part of Magellan Behavioral Health, responded to Psychiatric News in a statement, "Our goal first, and foremost, is the care of our members, and thus we are committed to rigorous standards for behavioral health care. Because of this commitment, we support the National Committee for Quality Assurance's accreditation program for managed behavioral health care organizations (MBHOs)."
"As part of a comprehensive quality improvement program and in compliance with NCQA standards for MBHOs, we conduct periodic site visits to providers who participate in our network. These visits typically involve reviews of patient records in an effort to ensure that care is provided appropriately."
Green Spring's statement continues, "Because we are especially sensitive to issues related to confidentiality, we have offered a number of alternative approaches to allay providers' concerns about these site visits. These alternatives include allowing providers to remove information that can identify a patient or to obtain a patient's consent prior to reviewing the record."
APA argues in the draft class-action complaint that it is unlawful and unethical for providers to turn over complete patient medical records to Green Spring for the purpose of its proposed quality assurance program without first obtaining voluntary and fully informed patient consent. The health insurance information release forms signed by patients when they enroll do not specifically mention disclosure for the purpose of quality assurance.
Moreover, providers' refusal to release psychiatric information for quality-assurance purposes without appropriate patient consent is not a breach of the providers' contract with Green Spring because providing such information would violate Maine law and public policy.
APA also asserts in the draft class-action complaint that unannounced site visits by Green Spring representatives to psychiatrists' offices during normal business hours can jeopardize patient privacy and the doctor-patient relationship.
To remedy these complaints, Green Spring must agree to the following conditions proposed by APA, according to Carnot. (These conditions are being negotiated among attorneys and will be part of a class-action complaint if not settled.)
Green Spring's statement concluded, "We are committed to working with our colleagues at APA to find a solution that allows us to fulfill our responsibility to ensure quality care while also addressing providers' concerns. We look forward to a mutually acceptable resolution of this issue."