I am happy to announce that early this week, the Holstein v. Magellan antitrust lawsuit was settled favorably for all mental health professionals in the U.S. The defendant Behavioral Managed Care Organizations (BMCOs) have signed an agreement stating that for a period of 5 years, they will not dismiss mental health professionals from their panels for patient advocacy, nor interfere with mental health professionals who inform patients about their potential treatments and options. This legal outcome is an important step in our struggle to help our patients to regain control of their own treatment. Also as part of the settlement, a conference is being scheduled between senior executives of the defendant BMCOs and representatives of the mental health professional community. We hope that the conference will lead to significant dialogue and changes. I expect to attend this forum, and invite your input and suggestions in this regard.

According to lead attorney Joseph Sahid

"The settlement provides relief for _all_ mental health professionals throughout the country that has never been achieved before, and gives mental health care professionals benefits that no other healthcare professionals enjoy. Thus 'termination without cause' clauses in contracts with the defendant managed care companies can no longer be enforced as written and will instead protect those trying to help their patients. Whatever is left of 'gag clauses' has been effectively nullified."

As a crucial first step, this settlement represents a turning point in our struggles with a predatory industry that at the bleakest hours of our servitude, had convinced so many of our colleagues that psychiatric treatment predicated on collaborative dialogue between patient and physician was a "thing of the past," and that those of us trying to resist were "dinosaurs" who would soon be extinct.

We are still involved in a monumental war against corporate financial interests that have for too long, attacked and devastated the ethical and professional foundations of our work of advocating for patients, and callously interfered with our efforts to help patients to gain a sense of ownership over their treatments and their lives. Despite the modest and legalistic wording of the settlement (see the full text of the press release approved by Judge Kaplan at the end of this message below), Godzilla has finally blinked and taken a step backward because of something we all did together!

One of the crucial advantages of the settlement is that for the first time BMCOs have been implicitly but _publicly_ affixed to a standard they adamantly refused to accept in the past, namely that clinicians must be protected in their right to advocate for patients! This principle will be enforced during the 5 year period under the aegis of the arbitration process incorporated into the settlement. Most likely, this will be the foundation upon which state legislatures, regulatory agencies, and courts through out the country will engrave this principle in stone!

Much credit goes to the perserverance and persistence of the individuals and allied mental health organizations who were bravely willing to enter the line of fire as named plaintiffs, including three APA District Branches (New Jersey, Michigan, and Washington Psychiatric Society); to Maria Lymberis, M.D., another psychiatrist plaintiff who was willing along with me, to face prolonged grilling by the teams of managed care company attorneys during the deposition phase of the proceedings; and to Edward Stephens, M.D. who courageously served as the pioneering lead plaintiff in the previous lawsuit (Stephens et al v. CMG), the precursor to Holstein v. Magellan.

All of us owe a special debt of gratitude to lead counsel Joseph R. Sahid, who along with his team of attorneys donated millions of dollars of their time over a period of years, and who at the end of the day, unfortunately received no compensation for themselves except for the moral satisfaction of having helped reverse part of the ravages of a rapacious and unregulated industry.

When the judge would not allow payment of the proposed attorneys fees incorporated into the preliminary settlement agreement, he offered to let Mr. Sahid withdraw the agreement. Mr. Sahid declined to do so because he did not want to jeopardize an outcome that provided important relief for his clients -- i.e. all us who treat patients as mental health professionals in the United States!

I want to express my thanks in particular to many of you who as individuals gave so freely of your moral support and contributions to help fund th litigation. There were also many professional associations that generously gave of their financial and moral support. Without these joint efforts on behalf of our patients and our profession, it would have been impossible to achieve such a rapid settlement. As you may be aware, antitrust litigation is exceedingly complex, can drag out for years, and even when won, can result in minimal returns.

What have we learned from all of this? We have learned that the managed care monolith is not invincible. By working together, holding fast to our traditional ethical principles rooted so firmly in deep respect for the human soul, we can stand fast against those corporate behemoths that would intimidate, devalue and blame us. Just as we help our patients overcome fears of impulses and anxieties they perceive at times to be like overwhelming monsters, we have learned that we can also help ourselves. Just as we empower our patients to believe in their own inner worth, and help them to develop a sense of ownership over their treatment and ultimately of their lives, we have learned we are not quite so helpless as we thought. Bless you all.

Sincerely,

Richard S. Epstein, M.D.
PSYCH-GRASSROOTS CO-CHAIR