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Court of Appeal Approves Removal of Orthopedist from MPN

CorVel Healthcare, a workers’ compensation system MPN, terminated the contract of Douglas J. Roger M.D., an orthopedic surgeon for two reasons: First, he was unreachable by independent reviewing physicians hired by the network to evaluate four nonstandard treatments he was regularly prescribing for his workers’ compensation patients. Second, he was prescribing those nonstandard treatments on a wholesale basis, and not taking the time to justify their application to particular patients. The Court of Appeal in the unpublished case of Roger v. CorVel Healthcare held that CorVel was well within its rights in terminating his contract.

The case becomes more complicated. The MPN did not comply with the contract as regards the process of termination. The contract provided for a graduated, three-step disciplinary process based on first, second, and third offenses: first a warning letter, second a set of counseling “sessions,” and only then, third, actual termination. And that did not happen. The network terminated the physician after one lengthy telephone discussion with one independent reviewing physician about one patient. The record is clear that Dr. Roger was not about to change his practice to conform to the network’s utilization review procedure, either by making himself readily accessible for peer review consultations, or by taking the time and effort to justify his nonstandard treatments on a patient-specific basis.

Dr. Roger regularly prescribed four nonstandard treatments for his workers’ compensation patients. The first is known as a “surface EMG.” An EMG can be done by needle, which is considered a separate procedure from surface EMGs, or it can be done by surface electrodes – hence the term “surface EMGs.” Surface EMG’s are controversial. Insurers, generally speaking, don’t like them. The other nonstandard treatments were two ointments and one “medical food.” The two ointments were a capsaicin compound referred to by the parties as wasabi-rub, the other a compound of various ingredients called Gaba-2K rub. The “medical food” was theramine tablets.Dr. Roger did not dispute that none of these four treatments are recommended for use in the medical treatment utilization schedule (MTUS) adopted by California Division of Workers’ Compensation. He prescribed them over 90 times, either individually or in some combination, over the course of the year following his sign-up with CorVel. And in each of those more than 90 cases, the proposed treatment was not “certified” for payment. Dr. Roger denigrates the non-certification memos as “cut and paste jobs” performed by nurses rather than actual doctors (even though they were signed by doctors), but cites no evidence to that effect. But Dr. Roger made himself practically unreachable during his tenure with CorVel. He testified he operated four offices during this period, and he had a personal policy of never returning any phone call from an independent reviewing physician unless he was at the office where the patient’s file was kept.

Even worse – and “worse” is the precise word the trial judge used for it – Dr. Roger resorted to the unethical practice of upcoding in order to be paid for the surface EMGs he prescribed.

Dr. Roger’s main theme, which is that a network like CorVel has no business telling fully qualified physicians – under the guise of utilization review – that they can’t prescribe what they think is best for their patients if it is otherwise perfectly legal. The Court of Appeal noted that “Dr. Roger himself was perfectly willing to accept denial of a prescribed treatment and simply assert a workers’ compensation lien later.”

The Court of Appeal affirmed the trial court judgment that Dr. Roger take nothing by his breach of contract action. The Court noted that “While Dr. Roger’s workers’ compensation business may have declined considerably as a result of his termination, we cannot say that his termination was as a result of CorVel’s failure to follow the three-step termination process. Termination was inevitable, independent of that process.”

Real Estate Agent Faces 14 Felony Charges

The Los Gatos Patch reports that Adrienne McGrath, 44, was arrested by Santa Clara County sheriff’s authoriteis in San Jose after being charged with 14 felony charges related to violations of the California Insurance Code. McGrath, whose occupation is described as a real estate agent in a sheriff’s arrest report, is facing three felonies for allegedly making a false fraudulent statement, either orally or in writing, of any fact material to the determination of the premium, rate, or cost of any policy of workers’ compensation insurance, for the purpose of reducing such premiums.

She is also being accused of four felonies related to willfully failing to collect or truthfully account for and pay unemployment insurance.

She’s additionally charged with two felonies related to knowingly undertaking or agreeing to pay without deduction from remuneration to workers the amount of any contributions to the disability fund required of such workers under the law.

Authorities also say McGrath committed two felonies for allegedly willfully failing to pay disability insurance and two felonies for failure or refusal to make unemployment insurance contributions.

A Santa Clara County sheriff’s arrest report also indicates McGrath faces two felonies for willfully misrepresenting facts to the determination of the premium, rate, or cost of any policy of workers’ compensation insurance issued or administered by the State Compensation Insurance Fund for the purpose of reducing the premium, rate, or cost of the insurance and one felony for making a false fraudulent statement.

Federal Court Decisions Create Opportunity to Reduce MSA Allocations

The Baird Formula is a method of reducing EDD liens proportionately, when a worker’s compensation claim is settled for less than its full amount. The formula was approved by the California Supreme Court in California-Western States Life Insurance Co. v. Industrial Accident Commission (Baird), 59 Cal.2d 257, 28 Cal.Rptr. 872, 379 P.2d 328 (1963). It seeks to assure fairness in proportional reductions of EDD liens by showing a reasonable estimate of the full value of the claims as if the worker had prevailed. The EDD lien is reduced so that the EDD does not receive a greater percentage of full recovery then does the injured worker. So, the question becomes, is it similarly possible to reduce the amount allocated to protect the interests of Medicare in a Workers’ Compensation Medicare Set Aside (WCMSA) situation so that CMS does not receive a greater percentage recovery than the claimant? While there are no cases on this point in the world of workers’ compensation claims, there are some new cases that may seem to agree with this concept in cases where a Liability Medicare Set Aside (LMSA) is required during the settlement of a liability case.

The United States District Court, W.D. Louisiana decided Benoit v. Neustrom, 2013 U.S. Dist. LEXIS 55971. on April 17, 2013. Michael Benoit suffered injuries while incarcerated. Michael Neustrom, as Sheriff of Lafayette Parish was sued for allegedly not recognizing his health condition, causing a delay in medical care leading to disabling neurologic injury. The Parties agreed to a settlement of $100,000 and Medicare claimed $2,777.78 for conditional payments it made related to the claim. Although the Parties did not contest what was owed to Medicare, there was concern regarding future Medical and CMS statements that its future interests must be protected. To do so, Plaintiff secured a LMSA with cost projections in the range of $277,758.62 – $333,267.02. Based on the settlement amount of only $100,000, an issue of how to fund the LMSA was obvious.

CMS was served notice of a Motion for Declaratory Judgment asking the Court how to proceed, but declined to appear. In lieu of its appearance, the U.S. Attorney sent its standard letter which included a handout from the MSP regional Coordinator for CMS in Region VI. According to such handout, Medicare’s interests must be protected, but CMS does not mandate a specific mechanism to protect those interests. It goes on to state the law does not require a “set – aside” in any situation, but it is [CMS] method of choice for workers’ compensation settlements .The law makes no distinction between workers’ compensation and liability cases. The implication therefore is that the LMSA would be a vehicle, but CMS has no approval mechanism in place. Absent a CMS approval, the LMSA could be later challenged by CMS.

Since CMS provides no other procedure to determine the adequacy of protecting Medicare’s interest for future medical, the Court decided it must act to fill the vacuum that is left. In doing so, the U.S. District Court made several important findings of fact, important to its determination which covered: 1) Jurisdictional basis; 2) Agreement that both liability and medical issues were contested; 3) The potential damage elements plaintiff would have recovered for had the case been tried; 4) The settlement amount of $100,000 represents a reasonable compromise; 5) Plaintiff will take more than 30 months to reach age 65; 6) A calculation of the allocation based on the settlement amount; 7) The need for Plaintiff’s wife to administer the fund, based on Plaintiff’s incapacitation; 8) The requirement to reimburse Medicare its conditional payment claim in full; and 9 ) No Party is attempting to maximize the settlement.

To arrive at the appropriate figure, the Court took the net settlement proceeds, after reimbursement of conditional payments to Medicare, attorneys’ fees and costs and divided it into the mid – point of the LMSA range that was presented to the Court, arriving at a ratio of 18.2%. That ratio was then applied to the net proceeds where the Court arrived at the $10,138 figure to fund the set-aside. The Court looked to the 11th Circuit decision in Bradley v. Sebelius for guidance. 621 F.3d 1330 (11th Cir. 2010). Bradley was an allocation case under the MSP with respect to conditional payments, holding that CMS must respect a judicial allocation based on the merits of the case.

Based upon the logic of these new federal decisions, perhaps it is time for the judicial creation of a “Baird” type formula for the resolution of conditional payments and set-aside allocations under California workers’ compensation law.

NCCI Says Work Comp Industry Recovering

The workers’ compensation market is seeing encouraging signs. Premiums grew for the second consecutive year, the combined ratio declined and claim frequency continued to improve at a pace slightly greater than its long-term historic rate of decline. According to the summary in the Insurance Journal, In 2012, the workers’ comp calendar combined ratio dropped six points from 2011, coming it at 109. The drop in combined ratio marks the first decrease since 2006, according to the State of the Line workers ‘compensation market analysis published by NCCI.|”By many measures, the industry condition is indeed improving,” said NCCI President and CEO Steve Klingel. “While we are pleased to see that the positives are beginning to outweigh the negatives, there remains great opportunity for improvement.”

Long-term challenges still linger over the future of workers’ comp, says Klingel. External forces such as the economy, healthcare reform, and new legislation could still negatively affect the market. “But for now, we view the overall industry condition as encouraging,” he says.

Net written premium (including state funds) also improved, increasing to $39.63 billion in 2012. The NCCI reports this is a 9 percent increase from 2011. Net written premiums increased 8 percent in 2011. The premium increases follow a cumulative 27 percent decline in premium from 2006-2010.

The report also revealed that lost-time claim frequency improved significantly in 2012 – down 5 percent on average in NCCI states. The 5 percent decline is slightly larger than NCCI’s long-term annual estimate of a of 2 to 4 percent decline per year. Previous NCCI research indicated that distortions in the calendar year premium data resulting from the recession and subsequent recovery affected our measure of claim frequency for 2010 and 2011. Current research indicates that those distortions are no longer significant for 2012.

Despite the improving conditions, the workers’ compensation line continues to deal with a variety of significant challenges, says NCCI Chief Actuary Dennis Mealy. “These include poor underwriting results, low investment yields, and continued uncertainty regarding the impact of the implementation of the federal healthcare reform bill,” he said.

Even so, the fact that the industry is seeing a return to a long-term pattern of declines in frequency and premiums are on the rise suggests that the underwriting performance of the industry, while still not good, is not as bad as it has been over the last two to three years, says NCCI’s Chief Economist Harry Shuford. “For the last three years the operating gain, which basically measures the overall profitability in workers’ compensation, has basically been zero for three years in a row,” Shuford said. “Investment income has been just sufficient enough to cover underwriting losses and there was nothing left over. This year there is some positive return due primarily from the improvement in underwriting results.” Like Mealy, Shuford told Insurance Journal that he sees investment yields as a concern for the future health of the workers’ comp market.

Federal Medicare Secondary Payer Law (MSP) Does Not Preempt State Comp Law

The United States Court of Appeals for the Fifth District (Texas) ruled that a claim for reimbursement of the costs for treatment for the effects of an industrial injury paid by Medicare, cannot circumvent the requirements of state workers’ compensation law. In other words, federal law does not preempt state law procedural requirements. Here is what happened in the case of Guadalupe Caldera vs The Insurance Company of the State of Pennsylvania.

Caldera injured his back at work in 1995. Workers’ compensation carrier Insurance Company of the State of Pennsylvania (“ICSP”) initially paid Caldera benefits pursuant to Texas state law. Still suffering from the injury, Caldera applied for and obtained Medicare benefits in 1998.

He then had two back surgeries: one in 2005 and another in 2006. Medicare paid for both, with costs totaling $42,637.41. Although Caldera did not seek preauthorization for either surgery from ICSP (a prerequisite for payment under Texas workers’ compensation law), he filed a claim with ICSP for these expenses, arguing that ICSP – not Medicare – was responsible for payment. An “Agreed Judgment” between ICSP and Caldera established that Caldera’s 1995 injury was the producing cause of the conditions that gave rise to his surgeries, but it did not liquidate any damages or require any payment.

Caldera filed a Medicare Secondary Payer Statute (MSP) reimbursement claim against ICSP in the state court action, seeking double-damages. At the time Caldera suffered no out-of-pocket loss for these costs. Medicare had taken no steps to recover these funds from ICSP or Caldera. His motivation – MSP contains a private right of action to incentivize citizens to aid the government in recovering funds erroneously paid by Medicare. (See 42 U.S.C. § 1395y(b)(3)(A)). A Medicare beneficiary may recover from his workers’ compensation carrier twice the amount that Medicare paid on his behalf if, among other things, the carrier qualifies as a “primary plan” – that is, if it “can reasonably be expected” to cover the expense “under a workmen’s compensation law or plan.” Id. § 1395y(b)(2)(A). To succeed, then, Caldera had to state a plausible claim that ICSP “can reasonably be expected” to pay for his surgeries under Texas workers’ compensation law.

ICSP answered that Caldera could not recover under the MSP because – regardless of the extent-of-injury issue – ICSP had no obligation to pay for surgeries that were not preauthorized in accordance with Texas workers’ compensation law. Caldera filed and lost a declaratory judgment action to determine whether the MSP preempts ICSP’s state-law defense. The United States Court of Appeals for the Fifth District (Texas) affirmed the dismissal in favor of ICSP.

The Court of Appeals noted that “Medicare serves as a back-up insurance plan to cover that which is not paid for by a primary insurance plan.” But, Caldera admits that he failed to obtain preauthorization for his surgeries, a state-law prerequisite for the receipt of workers’ compensation benefits from ICSP. Nevertheless, Caldera argues that ICSP qualifies as a “primary plan” that “can reasonably be expected” to pay because the MSP preempts the Texas preauthorization requirement. Caldera broadly argues that the MSP preempts any state laws that “impede the intent of recouping monies from primary payers” like ICSP.

The Court of Appeals agreed that “Congress explicitly prohibited workers’ compensation and other insurers from subordinating their payment obligations to those of Medicare.”. However, the court went on to state “[t]he MSP and its implementing regulations do not, however, extend so far as to eviscerate all state-law limitations on payment, as Caldera suggests. ….Indeed,numerous MSP regulations (indeed, an entire subchapter) presuppose the application of state workers’ compensation laws. …. In sum, we conclude that Congress intended the MSP to complement, not supplant, state workers’ compensation rules. This includes the preauthorization requirement that Caldera failed to meet before he filed suit.” The Court of Appeals concluded that Texas has gone to great lengths to craft a statutory structure that “carefully constructs rights, remedies, and procedures” to provide adequate coverage for injured workers…..That structure “contains detailed procedures and penalties for failures of the various interested parties to comply with statutory and regulatory requirements.” Id. at 440. “We will not upset this well-oiled machine absent a clear directive from Congress.”

WCAB Panel Allows Employer to Attend Applicant Deposition

Irene Yera claims to have incurred industrial injury to her neck, upper extremities, chest, nervous system and other body parts while employed as sales assistant by J.C. Penny.

During the course of investigating the claim, the employer scheduled Yera’s deposition. Yera appeared at the noticed time and location but refused to go forward in the presence of defendant’s store manager, who was designated as the employer’s representative. Defendant then petitioned to compel the deposition to proceed in the store manager’s presence, but the WCJ denied the petition. The defendant petitioned for removal to obtain an order to compel from the WCAB.

In his Report, the WCJ explained that he denied defendant’s motion because he was informed by applicant’s representative at that time that the presence of the store manager “would intimidate applicant.” However, the WCJ further writes that defendant is correct that applicant’s counsel did not seek a protective order prior to the deposition and that no specifics were provided at the conference “regarding applicant’s perception of being intimidated by the manager.” In the absence of such specifics, the WCJ agrees with defendant that it has the right to have the manager present during applicant’s deposition.

The WCAB panel granted the Petition for Removal and rescinded the decision denying defendant’s petition to compel in the case of Irene Yera v J.C. Penny.

The panel noted that there was no evidence from applicant identifying any right to privacy that would or could be affected if the store manager is present during the deposition.To the contrary, the only reason given by applicant’s representative to the WCJ for not proceeding at the deposition was that applicant would feel intimidated by the store manager’s presence. Such a summary assertion of subjective feelings is not sufficient reason to exclude the store manager from the deposition, particularly in light of the fact that applicant is represented by counsel and has remedies available to address any improper behavior that may occur at the deposition.

DWC Posts Proposed Changes to MPN Regulations

As part of its ongoing efforts to implement Senate Bill 863, the Division of Workers’ Compensation (DWC) has posted proposed changes to the existing Medical Provider Network (MPN) regulations to the online forum where members of the public may review and comment on the proposals. The reform provisions of SB 863 substantially modified the MPN requirements. The modifications include:

  • Expanding the types of entities who may qualify to have an MPN.
  • Establishing an MPN approval period of four years.
  • Allowing any person to submit a complaint against an MPN.
  • Providing a petition process to either revoke or suspend an MPN.
  • Authorizing DWC to conduct reviews of MPN s and assess administrative penalties for violations of statutory and regulatory requirements.

The proposed amendments to the MPN regulations modify regulatory definitions, which include a definition of an entity that provides physician network services. The regulations also detail the changes to MPN operating requirements, which include physician acknowledgments, Internet Web site postings of providers, medical access assistants, quality of care, geocoding and MPN disclosure requirements to medical providers. In addition, the regulations set the requirements for MPN approval for a period of four years and the procedural timelines for MPN re-approval.

Regarding compliance and enforcement, the proposed regulations set forth the process for filing a written complaint against an MPN, and the manner to petition DWC for the suspension or revocation of MPN status. Finally, the regulations detail more enforcement actions, establishing additional grounds for the probation, suspension, or revocation of an MPN, and the procedure by which MPNs are reviewed by the Division and assessed administrative penalties.

The proposed changes to the MPN regulations start with section 9767.1 of title 8 of the California Code of Regulations. The forum can be found online on the D WC website. Comments will be accepted on the forum until 5 p.m. on May 23 . Please feel free to participate in this important process.

Brookdale Inn Owner Pleads No Contest in Fraud Case

The Santa Cruz Sentinel reports that the owner of the Brookdale Inn and Spa pleaded no contest to felony insurance fraud and two misdemeanors related to unpermitted construction and a lack of worker’s compensation insurance. Sanjiv Kakkar, 51, faces less than a year of jail time, a $10,000 fine and restitution to an insurance company when he is sentenced in October. Judge Timothy Volkmann said in court that the sentence might be served through work release or another alternative. Prosecutor Kelly Walker said outside court that the pleas were “appropriate, given the circumstances.”

In 2011, inspectors found disturbed asbestos during a construction project at the Inn. Authorities told Kakkar not to allow anyone in the dining hall. Later that day, Kakkar held a Valentine’s Day luncheon with about 150 senior citizens, prosecutors said. None of the seniors were sickened. Kakkar pleaded guilty to a misdemeanor health and safety code violation for unlawfully operating the dining facility.

Kakkar and his wife, 49-year-old Neelam Kakkar, bought the Brookdale Lodge at 11570 Highway 9 in the summer of 2007 and renamed it. Built in the 1890s, it had hosted Marilyn Monroe and President Herbert Hoover in its heyday. It had 46 hotel rooms, 45 apartments, 30 storage units and a large restaurant and bar.

In 2008, a worker spoke with Sanjiv Kakkar about filing a worker’s compensation claim. But prosecutors said Kakkar dissuaded him from filing the claim. He pleaded no contest to felony insurance fraud related to dissuading the employee. Sanjiv Kakkar also pleaded no contest to felony insurance premium fraud because he paid some employees in cash to reduce the payroll amount he reported to insurers. Sanjiv Kakkar also failed to maintain worker’s compensation insurance, a misdemeanor to which he also pleaded no contest. Neelam Kakkar also had faced charges because she signed her name on some payroll documents, but her charges were dismissed in the plea agreement.

A 2010 civil suit brought by six former employees alleged that Kakkar bounced paychecks, inflicted emotional distress and did not provide rest and meal breaks, according to the civil filing. That case is due back in court July 25 potentially to set a trial date.

Also in 2010, a judge ordered Kakkar to pay $17,000 to the state Department of Fish and Game and other agencies after chemicals used to unclog a kitchen pipe killed about 50 endangered steelhead trout.

In 2009, a fire destroyed 20 apartments and displaced 65 people. County officials red-tagged some buildings on the property after the fire, and some remain closed. The Inn has not reopened since the properties were red-tagged.

Court of Appeal Rejects Peace Officer Presumption of Cardiac Injury

The Court of Appeal affirmed the denial of a peace officers presumed industrial disability retirement claim notwithstanding the accepted workers’ compensation claim. Here is what happened in the unpublished opinion of Henry Kirk v Retirement Board of of the City and County of San Francisco

Henry Kirk was a police officer for the San Francisco Police Department from 1975 until his retirement in June 2008 due to his heart-related physical impairment. His heart trouble appears to have surfaced in the 1980s, when he began to notice rapid heart beating and other symptoms, first, when exercising in 1983, and, next, when he passed out while driving a police vehicle in pursuit of a suspect in 1983 or 1984.

He was diagnosed with paroxysmal supraventricular tachycardia (PSVT) in 1990, high blood pressure in 1994, hypertensive cardiovascular disease and possible cardiomyopathy in 1997. In 1998 he was evaluated for his worker’s compensation claim. The evaluator determined that since the cardiomyopathy developed during the years he was a police officer, he qualified for workers’ compensation benefits under the “California Presumption Statute.” His treating physician however continued to express doubts about the diagnosis of cardiomyopathy.

On July 28, 2007, Kirk collapsed and lost consciousness while dancing at a private event, suffering a cardiac arrest. After initially receiving emergency medical care that included emergency catheterization, hypothermia treatment and life support, kirk received an implantable cardiac defibrillator. Then, following nearly six months of recuperation, appellant returned to police duty on January 19, 2008.

On January 17, 2008, Kirk was examined by Dr. Robert Blau in connection with his July 2007 workers’ compensation claim. Dr. Blau did not address the link (if any) between Kirk’s heart condition and his police service except to state “[he] has already received acknowledgement of his hypertension and cardiovascular disease being industrial.”

On March 18, 2008, Kirk suffered another cardiac arrest while driving home from work and effectively retired on June 28, 2008. Just before his retirement, on June 10, 2008, Kirk applied for an industrial disability retirement, identifying a “cardiac arrest” in July 2007 as his disabling condition. Dr. Thomas Allems found Kirk unfit to serve as a law enforcement officer in any capacity and thus “appropriately medically retired on a non-service connected basis.” With respect to the underlying cause of his heart trouble, Dr. Allems found it unrelated to his service as a police officer: He said that “[Kirks’s] dilated cardiomyopathy is likely idiopathic in nature; he may have a genetic predisposition. As a result of his cardiomyopathy he has had symptomatic supraventricular and ventricular arrhythmias, dating back to the 1980s, with eventual ventricular arrhythmic arrests on two occasions in July 2007 and March 2008. This sequence of events reflects the natural history of his underlying cardiomyopathy.” After acknowledging that his heart disease had been accepted for workers’ compensation as industrial, Dr. Allems nontheless concluded that “With reasonable medical probability, his cardiomyopathy . . . was unrelated to any factors of his employment as a San Francisco police officer. His heart pathology would have occurred at the same time (becoming symptomatic shortly after his employment began) and progressed at the same rate and requested the same degree of medical treatment absent his being employed as a peace officer.”

His industrial disability retirement was denied after an arbitrator adopted the conclusion of Dr. Allems. The City of San Franciso adopted the arbitrators award and Kirk appealed.

The Court of Appeal in the unpublished opinion of Henry Kirk v Retirement Board of of the City and County of San Francisco affirmed the denial of his disability retirement claim. The task on appeal was to determine whether the trial court’s judgment is supported by substantial evidence. Contrary evidence developed in his workers’ compensation claim does not require reversal, particularly in light of the great deference accorded lower court findings in writ. proceedings. The Court of Appeal concluded that Dr. Allems did more than simply point out the lack of evidence that the applicant’s condition was industrial. Dr. Allems provided factually-supported medical opinions demonstrating the non-industrial nature and non-industrial progression of appellant’s condition, thereby successfully rebutting the applicable presumption

Backlash Begins Over DSM-V

The new Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-V, will be published this month. Evaluations under California Workers’ Compensation law must be performed in accordance with the latest edition of this Manual. And according to a story published in the Guardian, pushback from the mental health community over this new edition has already begun.

In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) issued a statement declaring that, given the lack of evidence, it is time for a “paradigm shift” in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems”, used by psychiatry.

Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the DCP’s statement, said it was unhelpful to see mental health issues as illnesses with biological causes. “On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse,” Johnstone said.

The provocative statement by the DCP has been timed to come out shortly before the release of DSM-5, the fifth edition of the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders. The manual has been attacked for expanding the range of mental health issues that are classified as disorders. For example, the fifth edition of the book, the first for two decades, will classify manifestations of grief, temper tantrums and worrying about physical ill-health as the mental illnesses of major depressive disorder, disruptive mood dysregulation disorder and somatic symptom disorder, respectively. Some of the manual’s omissions are just as controversial as the manual’s inclusions. The term “Asperger’s disorder” will not appear in the new manual, and instead its symptoms will come under the newly added “autism spectrum disorder”.

The DSM is used in a number of countries to varying degrees. Britain uses an alternative manual, the International Classification of Diseases (ICD) published by the World Health Organization, but the DSM is still hugely influential – and controversial.

But Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King’s College London, said it was wrong to suggest psychiatry was focused only on the biological causes of mental distress. And in an accompanying Observer article he defends the need to create classification systems for mental disorder. “A classification system is like a map,” Wessely explains. “And just as any map is only provisional, ready to be changed as the landscape changes, so does classification.”