Vermont spent millions on suspect drug Zyprexa

From the Barre Montpelier Times Argus

As the lawsuits against Eli Lilly over its top-selling anti-schizophrenia drug Zyprexa began piling up in 2006, Vermont's state-run insurance program spent nearly $4 million on the drug, according to documents.

That amount may seem like a drop in the bucket when compared to Zyprexa's 2007 sales of $4.8 billion in the United States, but the payments through Vermont's Medicaid program came at a time when 10 states and upwards of 30,000 people were suing the company over the drug.

Launched in 1996, Zyprexa has become the top-selling medication for drug-maker Eli Lilly. But those sales are dropping as lawsuits and leaked corporate documents reveal a decade-long effort to downplay the side effects, including weight gain and an increased chance of diabetes, in the company's promotion of the drug.

Just this week the state of Alaska, population 670,000, settled its lawsuit against Eli Lilly for $15 million over what it claimed were increased Medicaid costs due to health problems associated with taking Zyprexa. That was the first state to settle with the company in the lawsuits.

Vermont is not one of the states now suing Eli Lilly. But on Thursday, the Vermont Association for Mental Health, a Montpelier-based advocacy organization, urged the state to pursue that legal option. Executive Director Ken Libertoff said this case was a "sad commentary" on the influence of the pharmaceutical industry.

"No one doubts that psychotropic medications can be an important part of treatment, but as this case will show, improper marketing, concealment of important health information and huge financial payments have polluted the environment," Libertoff said.

While it may not be suing Eli Lilly, Vermont is investigating how the company marketed its drug to doctors and others here, according to Julie Brill, Vermont's assistant attorney general. She said the state subpoenaed marketing materials and internal company documents detailing its marketing plan in January 2007.

Brill said that inquiry is still on-going and she was mum on further details. She said she did not know when more informa-tion on their investigation could be made available to the public.

"We do have an ongoing consumer protection investigation," she said.

The $3.96 million spent on Zyprexa by Vermont in 2006 appears to be an unusually high number – and impacted because that financial year was the start of the new federal Medicare Part D program that subsidized the cost of prescription drugs, according to Ann Rugg, the deputy director of the Office of Vermont Health Access, which oversees the publicly-funded insurance programs.

The spending has since dropped, although it is still in the millions. In 2007, $1.5 million was paid by the state and during the first three quarters of the current financial year, the state is on track to pay about $1 million.

Michael Hartman, the commissioner of the Vermont Department of Mental Health, said Thursday that all medications have potential side effects, but the situation with Zyprexa is especially troubling due to the allegation that the company went out of its way to downplay its health consequences.

He faulted the Food and Drug Administration for its lax authority over the testing of new drugs, saying the federal organization needs to rely more on independent tests as opposed to the ones submitted by the drug-makers.

"A patient needs to understand and have all the information about the medication to make an informed decision," he said.

Hartman said Zyprexa was likely marketed in Vermont in the same way that the drug was marketed in other states. He said there is an "awful lot of trust or acceptance that the information provided" to mental health professionals in the field is accurate.

"If we can find that there is reason to believe that this wasn't done properly … show a purposeful pattern of deceiving people, that is a door that could be explored," Hartman said when asked if Vermont should join other states in the Zyprexa lawsuits. More than 23 million people have taken Zyprexa since it hit the market as a medication to soothe hallucinations and delusions. But company documents leaked to the New York Times show that the company encouraged doctors to prescribe the drug "off-label," meaning for uses not approved by the FDA.

Federal law prohibits such off-label marketing, although doctors are allowed to prescribe drugs more freely.

Tens of thousands of lawsuits have also been filed over the side effects of the drug, which include massive weight gain and blood sugar boosts – all known risk factors for diabetes. So far, the company has paid out $1.2 billion to settle many of the lawsuits.

So far, Eli Lilly has maintained its innocence. The company did not return a phone call for comment Thursday, but an executive told the New York Times this week that "a settlement helps us get back to what we want to focus on as a company …"

Zyprexa has been an effective medication for some patients, but its use has dropped in recent years once reports of the side effects surfaced, according to Jonathan Wecker, a Montpelier psychiatrist.

"I don't remember any talk of these side effects when the drug first came out," he said. "And clearly, the association we've seen since to diabetes has caused this drug to drop off a bit."

The ironic twist to the surge and fall of Zyprexa is that a government-funded study has shown that the older antipsychotic medications can be just as effective as the newer, more expensive medications, according to Adrianne Fugh-Berman, an associate professor in the Department of Physiology and Biophysics at Georgetown University School of Medicine.

"The pharmaceutical companies have really gone out of their way to cast doubt on this government-funded trial in order to decrease its credibility in physicians' minds," said Fugh-Berman, who is also the director of PharmedOut, an independent, physician-led organization that provides information on pharmaceutical drugs.

More Victims of Psychiatrist Come Forward

Report from the Rutland Herald, out of Vermont.

Additional charges could be coming against a Bellows Falls psychologist who pleaded innocent last month to charges he molested and sexually assaulted one of his mentally ill clients.

Bellows Falls Police Sgt. David Bemis said police had received a couple of calls from other potential victims after news about Donald E. Sanborn III became public.

"We're looking into that; I'm not saying they are victims, they are potential victims," said Bemis.

Meanwhile, the Vermont attorney general's office filed amended charges against Sanborn which took note that he was a "caregiver" and thus could face a more severe penalty if convicted.

Linda Purdy, an attorney with the Medicaid fraud and residential abuse unit, said the charges called for a slight increase in the potential jail sentence, from five to seven years.

Purdy refused to comment on whether additional criminal charges might be filed against Sanborn because of the continuing investigation, and she declined to say whether Sanborn would be facing charges of Medicaid fraud.

"I can't confirm or deny that," Purdy said, but she noted the victim in the original case was a Medicaid recipient and that Sanborn was a Medicaid provider.

Sanborn, 65, of Bellows Falls, is charged with having the woman engage in sexual activity during a one-on-one individual mental-health treatment session in Sanborn's office in Bellows Falls.

The complaint against Sanborn became public when the woman's lawyer reported to Bellows Falls police last year that Sanborn was doing "naughty things" with her during her sessions.

The woman, who suffers from dissociative identity disorder and agoraphobia, had been seeing Sanborn since 2003. According to court records, the woman's husband said she acts like a 5-year-old when she is threatened, because of those disorders.

Around November 2006, Sanborn suggested the husband not attend the therapy session, and that continued for about six to seven months. The husband told police his wife would often act like the 5-year-old after sessions with Sanborn.

The husband found socks balled up and shoved into the back of a drawer, where they shouldn't have been and his wife told him they were socks "dirtied" by Sanborn.

The woman's lawyer, Robert Fisher of Brattleboro, later turned over the socks to the Bellows Falls police, who found they tested positive for Sanborn's DNA, according to court records.

Psychologist in Sexual Abuse Case

From the Brattleboro Reformer

Donald Sanborn III, 65, of Bellows Falls, pleaded not guilty Monday to charges that he sexually abused a patient.

Sanborn, a psychologist, has been accused by a patient of doing "naughty things" with her during her sessions for approximately three to four months, according to an affidavit from Bellows Falls Police Officer Jennifer Carroll.

When Carroll spoke to the alleged victim, she writes in the affidavit, the woman seemed "very frightened and closed off" and "asked me several times if I was her friend and asked if I worked for Dr. Sanborn."

The alleged victim's husband told Carroll he used to attend the sessions with his wife. The woman stated that Sanborn had been helpful in the past and referred to him as "Lancelot."

About six or seven months before the sessions stopped, however, the alleged victim's husband states that Sanborn suggested private sessions.

He said that his wife sometimes resorted to the mentality of a 5-year-old when she was uncomfortable and he often observed her in this state after she left her sessions, Carroll reported.

The woman told Carroll that Sanborn had frequently wanted to talk about sex with her and convinced her to participate in sexual activities with him, although she had told him she did not want to.

He allegedly also told her not to tell anyone. She told Carroll that "she was afraid Sanborn would come to her house and get her if she told anyone."

Sanborn was arrested over the weekend after a DNA test was done on a pair of the woman's socks. Carroll reports, "I received a laboratory report stating that the primary reportable types of sperm portions from some of the submissions of the socks matched those obtained from the standard from Donald Sanborn III."

According to a report from the Vermont Forensic Laboratory, though, "the secondary types are too limited to support meaningful conclusions."

Sanborn was released on conditions Monday that he not contact the victim or her husband and that he not see any female or "younger" patients until the case is closed.

If found guilty, Sanborn could face up to 10 years in prison, a fine of up to $10,300, or both.

A Decline in Psychiatric Salaries

It appears that it is becoming harder to make a living as a psychiatrist, or any other mental health counselor. We suspect that a hidden cause in this decline has something to do with the decline and fall of the profession itself, as more scandals rack psychiatry, and industry repute is left in tatters and shreds. Of course, they pin the blame on a number of other reasonable factors. But maybe they need to look in the mirror every once in a while, instead of trying to gain sympathy from government. People are reminded that if it wasn't for government funding, psychiatry as a medical specialty would be dead already.

From this report

When Heather Pierce sat down and did her taxes for last year, she was a bit surprised to learn that she earned only about $23,000 in 2006.

The Berlin psychiatrist said her income was far higher when she began practicing 20 years ago.

"I'm not looking for sympathy because I love what I do," she said this week. "But the reality is that I have not had a raise in four years."

More than a dozen Vermont psychiatrists working in the public and private sectors held a morning-long hearing at the Montpelier Statehouse on Tuesday and painted a picture of a mental health system that is nearing a crisis.

Years of low reimbursement rates from the government and the health insurance industry coupled with the difficulty in counseling Vermonters suffering from mental illnesses, a process that seems to defy traditional health improvement tracking, have brought the state's community system to a point of cracking, psychiatrists said.

"We need to keep these issues on the front burner," said Ken Libertoff, the executive director of the Vermont Association for Mental Health and the organizer of the meeting. "Otherwise over the next several years we will see this field greatly diminished."

Alice Silverman, a St. Johnsbury psychiatrist, said it is impossible to find an available psychiatrist for emergencies in the Northeast Kingdom. Those working in that area are booked for weeks, she explained, creating a major gap in mental health services in a troubled part of the state."There is not enough care," Silverman said. "The system is breaking. It's a crisis and this is shameful."

Jennifer FauntLeRoy, a Rutland psychotherapist, said her three years of sessions with a 40-year-old abuse survivor with serious health problems totaled $8,990 in costs. But the total amount paid by Medicaid ended up being just over $6,000, she said.

FauntLeRoy said sometimes she makes as little as 25 cents over minimum wage for the public mental health work she does. By comparison, she might make more than $30 an hour conducting private sessions for those who can afford out-of-pocket costs for sessions.

"I'm going to be out of business in five years if I continue getting Medicaid at this rate," she said.

Montpelier psychiatrist Francis Kalibat distributed a copy of Cigna Healthcare's preferred psychiatrist network in Vermont – the list of 15 doctors in the state that the company sends its consumers to.

Of those 15, Kalibat said he found only three who are taking patients right now. The rest of the list was full of out-dated information, doctors who have wait lists of up to a month even for urgent cases and one person who wasn't even a psychiatrist.

Kalibat referred to the list as "Cigna's phantom network of psychiatrists."

"If you are with Cigna, you are paying good money for a policy you can't use," he said.

Cigna Healthcare could not be reached for comment Wednesday.

Much of the frustration at the meeting was focused on the health insurance companies, and several psychiatrists expressed frustration at the recent news that officials such as former Blue Cross and Blue Shield of Massachusetts CEO William Van Faasen received about $19 million in extra compensation and bonuses last year – all while their own reimbursement rates are stagnant.

Leigh Tofferi, the director of government, public and community relations for Blue Cross and Blue Shield of Vermont, said its medical reimbursement rates are based on local and regional market rates.

Because the health care organization only has 200,000 members in Vermont – a small pool compared to most other states – it contracts its mental health services administration to Magellan Health Services, a Connecticut-based company, Tofferi said.

"My understanding is that the reimbursement rates are based on market analysis," he said. "We try to find a balance that will provide access and value for our customers."

Catamount Health – Vermont's new program for the uninsured that was rolled out this fall – also worries psychiatrists.

A provision in that law states that the "carrier shall pay a health care professional the lowest of the health care professional's contracted rate." Jonathan Weker, a psychiatrist from Montpelier, pointed out that members of his field are among the few that are subjected to contracted rates.

"This makes me wonder why I would want to become a Catamount provider," Weker said.

Christine Oliver, the deputy commissioner of Banking, Insurance, Security and Health Care Administration for Vermont, said that provision was added at the request of MVP Health Care.

"The problems with reimbursement rates for the mental health field seem to be a systemic issue," Oliver said. "The thinking was that it was better to address that and other access issues in specific legislation later on, which it seems the Legislature plans to do next year."

Rep. Michel Fisher, D-Lincoln, the vice-chairman of the House Human Services Committee, said that provision will be one of the issues he hopes to investigate when the second half of the legislative session begins in early January.

"The challenge for us is to boil down these concerns to a legislative agenda that is reasonable," Fisher told the group of psychiatrists on Tuesday.

Concerns over the health of the state's mental health system comes at a time when advocates and lawmakers will be looking to the coalition of psychiatrists across the state to take over the patient load that is now going to Waterbury's Vermont State Hospital.

Rep. Ann Donahue, R-Northfield, a prominent advocate for mental health issues in the Vermont House, said the community system needs a boost if lawmakers are going to shift away from the troubled and federally-decertified state hospital.

"There is a concern here that we really have lost some ground over the last few years," Donahue said.

Drugging prisoners ought to be a crime

A letter to the Editor in the Rutland Herald in Vermont

do not understand the lack of media or legislative outrage over the absurd level of psychotropic drugging of our prison population in Vermont. As reported in the July 1 Sunday Rutland Herald and Times Argus, nearly half of Vermont prisoners have been put on some form of psychiatric drug. Many of these prisoners have been put on powerful psychotropics with potentially serious, lifetime debilitating side effects. Why is this different from the reported mistreatment of prisoners at Guantanamo Bay?

Per the psychiatrist quoted in the article, many are simply being drugged as a means of control. No other state in the country comes remotely close to Vermont's level of psychiatric drugging of prisoners.

When this is combined with the fact that Vermont is ranked No. 2 for per capita drugging of schoolchildren (Ritalin, etc.) we have a real pattern of psychiatric abuse, which is going unquestioned and unchecked. One can only assume that the psychiatric and pharmaceutical industries are both profiting nicely.

It is both ironic and scary that we live in such an idyllic place, yet our population is being forcibly drugged at a level untouched by any other state in America. (Not that schoolchildren or prisoners have the legal ability to refuse the drugs.)

We are one of the few remaining states which have not passed legislation restricting the overuse and abuse of Ritalin and other psychotropic drugs on children. (And now add prisoners.) Both the psychiatric and pharmaceutical lobbies are active and strong in Vermont. Bills have been introduced in the Vermont Statehouse in recent years by a small number of both Democratic and Republican legislators to address this, but they have been killed in committee. It is time for our legislators to confront these abuses and bring them to an end.

Mark Elstner

Burlington

Psych meds use seen high in Vermont prisons

From the Boston Globe

Seroquel is an anti-psychotic drug designed for people struggling with schizophrenia or bipolar disorder.

Its possible side effects include high blood sugar, which can lead to diabetes, and tardive dyskinesia, which manufacturer AstraZeneca describes as "uncontrollable movements of the face, tongue, or other parts of the body" that can become permanent.

But it has been widely prescribed in Vermont prisons, where about 46 percent of inmates were on some kind of psychotropic medication last year, a fact seen as disturbing by prison rights advocates and corrections officials alike.

By the state's own estimates, Vermont has the highest percentage of inmates on psychotropic medication of any state in the country and the highest number of inmates getting more than one psychiatric medication. The next-closest state had 24 percent of its inmates on such drugs, state Department of Corrections health director Dr. Susan Wehry told a legislative committee last year.

Those figures count the full range of psychiatric drugs, everything from antidepressants to anti-psychotic medications like Seroquel. Because of the anti-psychotics' greater mind-altering effects and potential side effects, much of the concern has been focused on them.

"The problem in prison is (drugs are) given to a lot of people to quiet them down," said prison mental health expert Dr. Terry Kupers, a California psychiatrist. "They're over-prescribed for people who are not psychotic but who are not sleeping or who are causing disruptions in the prisons," he said.

According to internal Vermont Department of Corrections records obtained through a freedom of information request by The Associated Press:

• At Southern State Correctional Facility in Springfield, Seroquel was being given to 74 prisoners -- more than 20 percent of the prison's 350 inmates -- as of last July, even though only 38 were classified as "seriously mentally ill."
  
• Last July's list for the Springfield prison showed 77 more prescriptions had been written for other anti-psychotic drugs, including Zyprexa, Risperdal and Abilify.
  
• At Southeast State Correctional Facility in Windsor, a women's prison, nearly a third of its inmates were taking Seroquel in the same period.
  
• The state spent $1.76 million buying drugs for prisoners last year.

Experts say drugs are often used by prisons instead of more intensive -- and expensive -- talk therapy.

[...]

See the Boston Globe for the full article with opinion. The basic facts are as above.

Settlement Reached As Trial Nears In Psychologist Romance Case

From WCSH 6 in Vermont

New Hampshire woman has settled a lawsuit she filed accusing her psychologist of initiating a romantic relationship.

The details of the settlement between therapist Monica Descamps of Norwich, Vermont, and Jill Davis of New Hampshire were not released.

Jury selection in federal court in Burlington had been scheduled to begin Tuesday.

Davis sued her former therapist in May 2006.

In her lawsuit, Davis said she sought counseling with Descamps in February 2003, which lasted until February 2004. At that point the psychologist ended counseling and initiated a romantic relationship with Davis, which lasted nine months.

In court papers, Descamps acknowledged the improper conduct

.

Lawsuit against psychologist settled on eve of trial

via WCAX-TV in Vermont

A lawsuit against a Norwich psychologist accused of initiating a nine-month affair with a former patient was settled days before it was to go to trial.

The details of the settlement between Norwich therapist Monica Descamps and Jill Davis of New Hampshire were not released.

Jury selection in federal court in Burlington had been scheduled to begin Tuesday.

Davis sued her former therapist in May 2006.

In her lawsuit, Davis said she sought counseling with Descamps in February 2003, which lasted until February 2004. At that point the psychologist ended counseling and initiated a romantic relationship with Davis, which lasted nine months.

In court papers, Descamps acknowledged the improper conduct.

Patient accuses therapist of initiating illicit relationship

From the Burlington Free Press

When Jill Davis began therapy with psychologist Monica Descamps, she wanted help dealing with mild anxiety and stress.

Instead, the Norwich therapist, in violation of codes of medical ethics and sacrosanct tenets of the doctor-patient relationship, initiated a nine-month affair that left Davis severely depressed, hospitalized and suicidal, according to a series of formal allegations against Descamps.

The accusations have prompted a million-dollar lawsuit against the psychologist in federal court in Burlington, a complaint and critical finding by the Vermont Board of Psychological Examiners, a six-month suspension of Descamps' license, and strict conditions on her reopened practice.

"Descamps breached her continuing duty as a psychologist," reads a section of Davis' lawsuit, "by violating professional boundaries that should have properly existed."

Davis, a New Hampshire woman in her 40s, is seeking a jury trial and "fair, just and adequate" compensation: the $1 million limit of Descamps' insurance policy, according to the lawsuit and other court papers. The case is proceeding in federal court in Burlington because the dispute involves residents of two states.

Such conduct, which is prohibited by major associations of medical and mental-health professionals, occurs rarely but can be serious and detrimental, experts said.

"The power is entirely in the hands of the clinicians, and even more so in psychiatry, because they're probing into such intimate areas," said Robert Macauley, medical director of clinical ethics at Fletcher Allen Health Care in Burlington. "The potential for harm for the patient and even the therapist is so great. This is violating a really core principle."

Descamps has admitted her improper conduct -- she turned herself in to state regulators -- but is contesting the amount of money her former patient and lover is seeking. Descamps disputes the characterization that her actions were as detrimental as Davis claims, said her attorney, Eric Poehlmann of Burlington law firm Downs Rachlin Martin.

"Yes, that did happen, and obviously it was improper, but she stepped up to the plate at the end," Poehlmann said. "She cut off the relationship. She self-reported to the professional conduct board."

Lawyers met with a judge this month in U.S. District Court in Burlington for a hearing about a dispute involving settlement negotiations. Davis' attorney has accused Descamps' insurance company of negotiating in bad faith. The firm, Ace American Insurance Co. of Philadelphia, is arguing that Descamps' policy offers no coverage for "licentious, immoral, amoral, or other behavior which led to or culminated in any sexual act," company lawyers wrote in their own court papers.

A hearing on that issue is scheduled for early May, but the question of whether Ace must pay a potential verdict against Descamps is unlikely to affect the underlying case. "That will be litigated at some point in the future," said Davis' attorney, John Maley of Burlington firm Sylvester & Maley.

A trial could begin as early as June.

Ethical prohibitions

Affairs between doctors and current patients violate codes of conduct from the American Medical Association, the American Psychological Association and the American Psychiatric Association. The Medical and Psychological associations also discourage sexual relationships between doctors and former patients and require two-year "waiting periods." The Psychiatric Association prohibits such contact at any time.

"The necessary intensity of the treatment relationship may tend to activate sexual and other needs and fantasies on the part of both patient and psychiatrist, while weakening the objectivity necessary for control," reads a passage of the Psychiatric Association's policy. "Additionally, the inherent inequality in the doctor-patient relationship may lead to exploitation of the patient. Sexual activity with a current or former patient is unethical."

A 1995 study published in the journal Canadian Psychology found that male mental-health practitioners violated those rules nearly five times more often than their female counterparts. The study said 1.7 percent of female and 8.3 percent of male psychologists and psychiatrists reported having sexual contact with a client.

Macauley, the Fletcher Allen medical ethicist, said the Descamps case is the first Vermont incident he's heard of involving sexual contact between a therapist and a former patient. Macauley, who also teaches at the University of Vermont and advises his students "never ever ever" to have a relationship even with a former patient, said doctors hold more power in relationships with patients, and people who seek counseling can transfer their feelings for someone else in their lives to the therapist.

"It raises the question of: Could the relationship be consensual, because is the person the patient is in love with the psychiatrist or the other person?" Macauley said.

The allegations

In Davis' case, according to her lawsuit, she sought counseling with Descamps in February 2003 for treatment of "low-level anxiety resulting from starting osteopathic school and her long-time partner's illness."

The partner, whom the lawsuit does not identify, died that November. Davis, depressed over the death, continued therapy with Descamps until February 2004, when the psychologist ended counseling and initiated a romantic relationship that lasted nine months, according to the lawsuit and findings from the professional conduct board.

During therapy, Descamps failed to manage the transference of Davis' feelings, and also her own "counter-transference," according to the lawsuit, which was filed in May 2006. Descamps also shared with Davis details of the lives and troubles of some of her other patients, violating their right to privacy, the professional board determined.

As a result of the relationship, the complaint contends, Davis suffered post-traumatic stress disorder, major anxiety attacks, sleeping problems, depression and thoughts of suicide. Davis requires ongoing hospitalizations, medication and extensive psychiatric care, according to the lawsuit.

Poehlmann, Descamps' attorney, said the scope of Davis' injuries will be a central issue at trial. For instance, the defense argues Davis already was enduring PTSD when the relationship began.

"A lot of her complaints are the exact same thing she had been suffering before," Poehlmann said. "It's hard to tell how much of that is the result of Dr. Descamps' conduct. Essentially, we're saying, 'You had it before, and how much worse did Dr. Descamps make it?'"

Descamps, a 1989 University of Vermont graduate who is in her 40s, declined to comment. Maley, Davis' attorney, declined to say how his client is doing or to comment on the substance of the allegations.

The Board of Psychological Examiners took up the case in September 2005 and issued an opinion signed Feb. 1, 2006, concluding Descamps engaged in unprofessional conduct. The board suspended the psychologist's license for two years but stayed all but six months of the term. The suspension began in July, and her license was reinstated Jan. 1, according to information from the Secretary of State's Office.

As part of the board's decision, Descamps also was required to enroll in three graduate-level courses: one about professional boundaries, another on ethics, and a third on client confidentiality.