After Every Adverse Communication from a Health Plan

After every adverse decision or letter from a Health Plan, a letter of complaint about the Medical Director should be sent to the licensing board. Let them spend their time being investigated, and their money hiring lawyers. As they make it tough to do our jobs, so should we return the favor. Here is an example.

State Board of Medicine
P.O. Box 2649, Harrisburg, PA 17105-2649
Phone:             (717) 783-1400      
Fax: (717) 787-7769
ST-MEDICINE@pa.gov

RE: Unprofessional Conduct; X, MD; Medical Director,
Y Health Plan,
Dear Doctor:
I enclose a copy of a letter from Dr. X. I request that it be investigated for its unprofessional conduct. The blacked out areas have a single patient name. General opinion, commentary, and criticism have First Amendment immunity. This letter’s specific demands, criticisms, etc., represent the practice of medicine, because they are about a specific patient. They are therefore under your jurisdiction.

1) Y is a quasi-governmental organization with the ability to punish doctors. Its actions require a fair hearing. That was not granted nor even offered.

2) I believe Dr. X is not a qualified psychiatrist. He is therefore criticizing doctors outside his scope of knowledge or experience, two psychiatrists. I am board-certified in psychiatry. The Mcare Act requires that any governmental medical action be based on the opinion of an expert with qualifications equal to mine. This letter violates that statute.

3) Assume nothing was wrong with the procedure of Y. This doctor is still giving specific, technical, medical advice about a patient he has never met, nor whose clinical record he has reviewed.

4) His allegation of multiple prescribers of a psychotropic drug over 45 days fails to acknowledge that Dr. Z and I work for the same clinic. We are providing coverage for each other, using the same facility, reviewing the same chart, and seeing the patient when follow up visits are due. There is therefore good continuity of care, not multiple, unrelated prescribers. Clozapine is prescribed to patients who have failed to respond to multiple neuroleptic tranquilizers, and remain dangerous to themselves and to others. Not seeing such patients regularly is substandard care. He is also receiving Seroquel, to reduce the dose of required clozapine, a desirable goal given the side effects of this medication.

Weasel clauses in the standard insert do not detract from the seriousness of the allegation of medical mismanagement being made by this quasi-governmental organization.

Sincerely Yours,

David Behar, M.D.