Stefan Kruszewski: Whistleblower charges medical oversight bureau with corruptio

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[sSRI-Research] Stefan Kruszewski: Whistleblower charges

medical oversight bureau with corruption

 

 

 

 

 

BMJ 2004;329:69 (10 July), doi:10.1136/bmj.329.7457.69

 

News

 

Whistleblower charges medical oversight bureau with corruption

 

http://bmj.bmjjournals.com/cgi/content/full/329/7457/69

 

Jeanne Lenzer

New York

 

Dr Stefan Kruszewski, a psychiatrist hired by the Bureau of Program

Integrity in the Pennsylvania Department of Public Welfare, filed a

law suit on 1 July in a federal court in the Middle District of

Pennsylvania, charging that he was fired on 11 July 2003 after he

uncovered widespread abuse and fraud in the bureau.

 

Dr Kruszewski's role at the bureau was to oversee the state's mental

health and substance misuse programmes to protect against fraud,

waste, and abuse.

When he uncovered serious abuses, including deaths of children in the

state's custody possibly due to substandard care and the off-label use

of potent atypical antipsychotic medications, " they fired the

messenger, " Dr Kruszewski told the BMJ.

 

Dr Kruszewski's efforts to clarify the causes of death in four

children and one adult in the state's care were blocked when he was

denied postmortem or coroner's reports and hospital records. Some of

the patients were taking as many as five antipsychotic medications at

the same time-something Dr Kruszewski says is " hard to justify. "

 

When Dr Kruszewski warned that off-label use of the drugs was

potentially harmful to patients and could expose the state to

liability he was told that " it's none of your business, " said Dr

Kruszewski.

 

Dr Kruszewski charges in his suit that a number of drug companies used

" political friendships, money, and other emoluments " to achieve " a

level of influence with Pennsylvania's state government " and with the

" current, president of the United States, George W Bush " to promote

" the use of their products in violation of the law and of the rights

of Pennsylvania citizens. "

 

Dr Kruszewski charges that corrupt practices, supported by political

contributions from drug companies, resulted in off-label use of

medication, misuse of medication that resulted in the deaths of

children under the care of the Pennsylvania Office of Medical

Assistance and the Bureau of Program Integrity, overmedication of

adults and children, and fraudulent billing, among other abuses.

 

His charges mirror those of other whistleblowers, including Allen

Jones, who reported that drug companies gave money to officials with

influence over the Pennsylvania state formulary (19 June, p 1458), and

David Franklin, who recently won a $240m (£131m; 195m) settlement with

Pfizer for its promotion of the off-label use of gabapentin

(Neurontin) (22 May, p 1217).

 

Dr Stefan Kruszewski warned against off-label use of drugs

 

Dr Kruszewski told the BMJ that it was money and influence, not good

medicine, that drove prescribing practices. " There was horrendous

polypharmacy, " said Dr Kruszewski. " They were putting almost all

patients on the same concoction of antipsychotic and antiseizure

drugs-but many of the patients weren't psychotic and they didn't have

seizures. Many were simply drug addicts. This [kind of prescribing]

didn't happen five years ago. "

 

Political and drug company influence, said Dr Kruszewski, was evident

when George W Bush, then governor of Texas, bragged about the Texas

Medication Algorithm Plan (TMAP) during his presidential campaign

while at the same time receiving large campaign contributions from the

same drug companies that funded-and benefit from-the medication

algorithm (19 June, p 1458).

TMAP recommends the use of newer, more expensive, antipsychotics and

antidepressants-drugs manufactured by the same companies that paid for

the development of TMAP. One of Dr Kruszewski's supervisors was

instrumental in bringing TMAP to Pennsylvania.

 

When Allen Jones, an investigator with the Office of the Inspector

General of Pennsylvania, discovered that an off the record bank

account was funded by drug companies to pay state officials to promote

TMAP, he was fired for persisting with the investigation after he was

warned off, according to his whistleblower suit.

 

Dr Kruszewski, who voted for Bush in the 2000 presidential election,

now regrets his vote, saying, " I was terminated because I did my job.

It turns out that drug companies and politicians were influencing the

drugs prescribed for patients. "

 

A spokeswoman for the Pennsylvania Department of Public Welfare said

the department never commented on pending litigation.

 

 

 

 

 

 

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